Transradial approach tied to better bleeding and survival outcomes in STEMI with cardiogenic shock: Study
USA: Transradial access (TRA) in percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) with cardiogenic shock (CS) is tied to lower bleeding complications and mortality versus transfemoral access (TFA), says a recent study. The two treatments, however, were associated with similar TIMI3 (Thrombolytics in Myocardial Infarction) flow and procedural success rate. The study appears in European Heart Journal - Quality of Care and Clinical Outcomes.
Previous studies have shown that in STEMI, transradial access for PCI is associated with less bleeding and mortality than TFA. However, patients in cardiogenic shock are often given the treatment of TFA. Andrew M Goldsweig, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, and colleagues, therefore, aimed to compare the safety and efficacy of TRA vs. TFA in cardiogenic shock in a meta-analysis.
For this purpose, the researchers searched the online databases for studies comparing TRA to TFA in PCI for CS. Outcomes included in-hospital, 30-day and ≥ 1 year mortality, major and access site bleeding, procedural success, TIMI3 (Thrombolytics in Myocardial Infarction) flow, fluoroscopy time and contrast volume.
A total of six prospective and eight retrospective studies (TRA n = 8032, TFA n = 23 031) were identified.
The study yielded the following findings:
- TRA was associated with lower in-hospital (RR 0.59), 30-day and ≥ 1 year mortality, as well as less in-hospital major (RR 0.41) and access site bleeding (RR 0.42).
- There were no statistically significant differences in post-PCI coronary flow grade, procedural success, fluoroscopy time, and contrast volume between TRA vs. TFA.
To conclude, In PCI for STEMI with cardiogenic shock, transradial access is associated with significantly lower mortality and bleeding complications than transfemoral access while achieving similar TIMI3 flow and procedural success rates.
Reference:
Muhammad Junaid Ahsan, Soban Ahmad, Azka Latif, Noman Lateef, Mohammad Zoraiz Ahsan, Waiel Abusnina, Sandeep Nathan, S Elissa Altin, Dhaval S Kolte, John C Messenger, Mark Tannenbaum, Andrew M Goldsweig, Transradial versus transfemoral approach for percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by cardiogenic shock: a systematic review and meta-analysis, European Heart Journal - Quality of Care and Clinical Outcomes, 2022;, qcac018, https://doi.org/10.1093/ehjqcco/qcac018
