Characteristics and Outcome in Cardiogenic Shock according to Vascular Access Site for PCI. (2024)

Affiliation

• Peters EJ; Department of Cardiology, Heart Center, Amsterdam University Medical Centre, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
• Bogerd M; Department of Cardiology, Heart Center, Amsterdam University Medical Centre, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
• Ten Berg S; Department of Cardiology, Heart Center, Amsterdam University Medical Centre, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
• Timmermans MJC; Netherlands Heart Registration, Utrecht, The Netherlands.
• Engström AE; Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
• Thiele H; Department of Internal Medicine/Cardiology, Heart Centre Leipzig at the University of Leipzig and Leipzig Heart Science, Leipzig, Germany.
• Jung C; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
• Schrage B; Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.
• Sjauw KD; St. Antonius Hospital, Nieuwegein, The Netherlands.
• Verouden NJW; Department of Cardiology, Heart Center, Amsterdam University Medical Centre, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
• Teeuwen K; Heart Center, Department of Interventional Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
• Dedic A; Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands.
• Meuwissen M; Department of Cardiology, Amphia Hospital, Breda, The Netherlands.
• Danse PW; Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands.
• Claessen BEPM; Department of Cardiology, Heart Center, Amsterdam University Medical Centre, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
• Henriques JPS; Department of Cardiology, Heart Center, Amsterdam University Medical Centre, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.

ABSTRACT

BACKGROUND:

The optimal vascular access site for percutaneous coronary interventions (PCI) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains uncertain. While observational data favor transradial access (TRA) due to lower complication rates and mortality, transfemoral (TFA) PCI offers advantages such as shorter access and procedure times, along with quicker escalation to mechanical circulatory support (MCS). In this study, we aimed to investigate factors associated with a transfemoral approach and compare mortality rates between TRA and TFA in AMI-CS patients undergoing PCI.

METHODS:

Data from a nationwide registry of AMI-CS patients undergoing PCI (2017-2021) were analyzed. We compared patient demographics, procedural details, and outcomes between TRA and TFA groups. Logistic regression identified access site factors and radial-to-femoral cross-over predictors. Propensity score matched (PSM) analysis examined the impact of access site on mortality.

RESULTS:

Of 1562 patients, 45% underwent TRA PCI, with an increasing trend over time. TFA patients were more often female, had a history of coronary artery bypass grafting (CABG), lower blood pressure, higher resuscitation and intubation rates, and elevated lactate levels. After PSM, 30-day mortality was lower in TRA (33% vs. 46%, p <0.001). Predictors for cross-over included left coronary artery interventions, multivessel PCI, and MCS initiation.

CONCLUSION:

Significant differences exist between TRA and TFA PCI in AMI-CS. TFA was more common in patients with worse hemodynamics and was associated with higher 30-day mortality compared to TRA. This mortality difference persisted in the propensity score matched analysis.