TY - JOUR
T1 - Improved in-hospital outcome for radial access in a large contemporary cohort of primary percutaneous coronary intervention
AU - Hasun, Matthias
AU - Dörler, Jakob
AU - Alber, Hannes F
AU - Bauer, Axel
AU - Berger, Rudolf
AU - Christ, Günter
AU - Frick, Matthias
AU - Hoppe, Uta C
AU - Huber, Kurt
AU - Lamm, Gudrun
AU - Laßnig, Elisabeth
AU - von Lewinski, Dirk
AU - Rab, Anna
AU - Roithinger, Franz X
AU - Schuchlenz, Herwig
AU - Siostrzonek, Peter
AU - Sipötz, Johann
AU - Stefenelli, Thomas
AU - Steinwender, Clemens
AU - Edlinger, Michael
AU - Weidinger, Franz
N1 - Funding Information:
We thank all participating centres who contributed to this study. Funding: The Austrian Acute PCI Registry (AAPCI) is supported by the Austrian Society of Cardiology.
Publisher Copyright:
© 2021 AME Publishing Company. All rights reserved.
PY - 2021/6
Y1 - 2021/6
N2 - BACKGROUND: Randomised controlled trials have shown diverse results for radial access in patients undergoing primary percutaneous coronary intervention (PPCI). Moreover, it is questionable whether radial access improves outcome in patients with cardiogenic shock undergoing PPCI. We aimed to investigate the outcome according to access site in patients with or without cardiogenic shock, in daily clinical practice.METHODS: For the present analysis we included 9,980 patients undergoing PPCI between 2012 and 2018, registered in the multi-centre, nationwide registry on PCI for myocardial infarction (MI). In-hospital mortality, major adverse cardiovascular events (MACE), and net adverse clinical events (NACE) until discharge were compared between 4,498 patients with radial (45%) and 5,482 patients with femoral (55%) access.RESULTS: Radial compared to femoral access was associated with lower in-hospital mortality (3.5% vs. 7.7%; P<0.01). Multivariable logistic regression analysis confirmed reduced in-hospital mortality [odds ratio (OR) 0.57, 95% confidence interval (CI): 0.43 to 0.75]. Furthermore, MACE (OR 0.60, 95% CI: 0.47 to 0.78) as well as NACE (OR 0.59, 95% CI: 0.46 to 0.75) occurred less frequently in patients with radial access. Interaction analysis with cardiogenic shock showed an effect modification, resulting in lower mortality in PCI via radial access in patients without, but no difference in those with cardiogenic shock (OR 1.78, 95% CI: 1.07 to 2.96).CONCLUSIONS: Radial access for patients with acute MI undergoing PPCI is associated with improved survival in a large contemporary cohort of daily practice. However, this beneficial effect is restricted to hemodynamically stable patients.
AB - BACKGROUND: Randomised controlled trials have shown diverse results for radial access in patients undergoing primary percutaneous coronary intervention (PPCI). Moreover, it is questionable whether radial access improves outcome in patients with cardiogenic shock undergoing PPCI. We aimed to investigate the outcome according to access site in patients with or without cardiogenic shock, in daily clinical practice.METHODS: For the present analysis we included 9,980 patients undergoing PPCI between 2012 and 2018, registered in the multi-centre, nationwide registry on PCI for myocardial infarction (MI). In-hospital mortality, major adverse cardiovascular events (MACE), and net adverse clinical events (NACE) until discharge were compared between 4,498 patients with radial (45%) and 5,482 patients with femoral (55%) access.RESULTS: Radial compared to femoral access was associated with lower in-hospital mortality (3.5% vs. 7.7%; P<0.01). Multivariable logistic regression analysis confirmed reduced in-hospital mortality [odds ratio (OR) 0.57, 95% confidence interval (CI): 0.43 to 0.75]. Furthermore, MACE (OR 0.60, 95% CI: 0.47 to 0.78) as well as NACE (OR 0.59, 95% CI: 0.46 to 0.75) occurred less frequently in patients with radial access. Interaction analysis with cardiogenic shock showed an effect modification, resulting in lower mortality in PCI via radial access in patients without, but no difference in those with cardiogenic shock (OR 1.78, 95% CI: 1.07 to 2.96).CONCLUSIONS: Radial access for patients with acute MI undergoing PPCI is associated with improved survival in a large contemporary cohort of daily practice. However, this beneficial effect is restricted to hemodynamically stable patients.
KW - Cardiogenic shock
KW - Outcome
KW - Primary percutaneous coronary intervention (PPCI)
KW - Radial access
KW - Registry
UR - http://www.scopus.com/inward/record.url?scp=85108832095&partnerID=8YFLogxK
U2 - 10.21037/cdt-20-977
DO - 10.21037/cdt-20-977
M3 - Journal article
C2 - 34295699
SN - 2223-3652
VL - 11
SP - 726
EP - 735
JO - Cardiovascular Diagnosis and Therapy
JF - Cardiovascular Diagnosis and Therapy
IS - 3
ER -