Format

Send to

Choose Destination
See comment in PubMed Commons below
Am Heart J. 2014 Jun;167(6):900-8.e1. doi: 10.1016/j.ahj.2014.03.007. Epub 2014 Mar 27.

Arterial access site utilization in cardiogenic shock in the United Kingdom: is radial access feasible?

Author information

1
Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, United Kingdom. Electronic address: mamasmamas1@yahoo.co.uk.
2
Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, United Kingdom.
3
University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom.
4
Worcestershire Royal Hospital, Worcester, United Kingdom.
5
Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, United Kingdom.
6
Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom.
7
Institute of Population Health Science, University of Manchester, Manchester, United Kingdom.
8
The James Cook University Hospital, Marton Road, Middlesbrough, United Kingdom.
9
Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.

Abstract

BACKGROUND:

Cardiogenic shock (CS) remains the leading cause of mortality in patients hospitalized with acute myocardial infarction (AMI). The transradial access site (TRA) has become increasingly adopted as a default access site for percutaneous coronary intervention (PCI); however, even in experienced centers that favor the radial artery as the primary access site during PCI, patients presenting in CS are often treated via the transfemoral access site (TFA); and commentators have suggested that CS remains the final frontier that has given even experienced radial operators pause. We studied the use of TRA in patients presenting in CS in a nonselected high-risk cohort from the British Cardiovascular Intervention database over a 7-year period (2006-2012).

METHODS:

Mortality (30-day) and major adverse cardiac and cerebrovascular events (a composite of in-hospital mortality, in-hospital myocardial reinfarction, target vessel revascularization, and cerebrovascular events) were studied based on TFA and TRA utilization in CS patients. The influence of access site selection was studied in 7,231 CS patients; TFA was used in 5,354 and TRA in 1,877 patients.

RESULTS:

Transradial access site was independently associated with a lower 30-day mortality (hazard ratio [HR] 0.56, 95% CI 0.46-0.69, P = 0 < .001), in-hospital major adverse cardiac and cerebrovascular events (HR 0.64, 95% CI 0.53-0.76, P < .0001) and major bleeding (HR 0.37, 95% CI 0.18-0.73, P = .004).

CONCLUSIONS:

Although the majority of PCI cases performed in patients with cardiogenic shock in the United Kingdom are performed through the TFA, the radial artery represents an alternative viable access site in this high-risk cohort of patients in experienced centers.

PMID:
24890541
DOI:
10.1016/j.ahj.2014.03.007
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center