title: Early and late outcomes after primary percutaneous coronary intervention by radial or femoral approach in patients presenting in acute ST-elevation myocardial infarction and cardiogenic shock.
abstract: BACKGROUND
  Although radial approach is increasingly used in percutaneous coronary interventions (PCIs) including in acute myocardial infarction (MI), patients with cardiogenic shock have been excluded from comparisons with femoral approach. The aim of our study was to compare clinical outcomes in patients undergoing primary PCI with cardiogenic shock by radial and femoral approach.
  
  
  RESULTS
  From 2,663 patients presenting with ST-elevation MI in 2 large volume radial centers, we identified 197 patients (7.4%) with signs of cardiogenic shock immediately before undergoing primary PCI. Radial approach was used in 55% of cases when at least 1 radial artery was weakly palpable, either spontaneously or after intravenous noradrenaline bolus. Patients in the radial group were older (69 ± 12 vs 64 ± 12 years, P = .010), had less diabetes (13% vs 26%, P = .028), and required less often intubation prior PCI (42% vs 66%, P = .0006) or intraaortic balloon pump (36% vs 55%, P = .0096). Mortality at 1 year was 44% in the radial group and 64% in the femoral group (P = .0044). Independent predictors of late mortality included radial approach (hazard ratio [HR] 0.65, 95% CI 0.42-0.98, P = .041), the use of glycoprotein IIb-IIIa receptor inhibitors (HR 0.63, 95% CI 0.40-0.96, P = .032), baseline creatinine ≥110 μmol/L (HR 3.34, 95% CI 2.20-5.12, P < .0001), initial glycemia >200 mg/dL (HR 2.02, 95% CI 1.34-3.11, P = .0008), and age >65 years (HR 1.80, 95% CI 1.18-2.79, P = .006).
  
  
  CONCLUSIONS
  Radial approach was safe and feasible in more than half of the patients with ST-elevation MI and cardiogenic shock treated by primary PCI. After adjustment for baseline and procedural characteristics, radial approach remained associated with better survival. However, prognosis of patients undergoing primary PCI in cardiogenic shock remains poor.
authors: University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
authors: Ivo
authors: I
authors: Bernat
authors: Eltigani
authors: E
authors: Abdelaal
authors: Guillaume
authors: G
authors: Plourde
authors: Yoann
authors: Y
authors: Bataille
authors: Jakub
authors: J
authors: Cech
authors: Jan
authors: J
authors: Pesek
authors: Jiri
authors: J
authors: Koza
authors: Stepan
authors: S
authors: Jirous
authors: Jimmy
authors: J
authors: Machaalany
authors: Jean-Pierre
authors: JP
authors: Déry
authors: Olivier
authors: O
authors: Costerousse
authors: Richard
authors: R
authors: Rokyta
authors: Olivier F
authors: OF
authors: Bertrand
mesh_terms: D000368:Aged; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D017534:Radial Artery / Q000601:surgery*; D012770:Shock, Cardiogenic / Q000188:drug therapy / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome