title: Arterial access site utilization in cardiogenic shock in the United Kingdom: is radial access feasible?
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.
authors.affiliation: 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.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, United Kingdom.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Anderson
authors.affiliation: University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom.
authors.forename: Karim
authors.initials: K
authors.lastname: Ratib
authors.affiliation: Worcestershire Royal Hospital, Worcester, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Routledge
authors.affiliation: Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, United Kingdom.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Neyses
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Fraser
authors.affiliation: Institute of Population Health Science, University of Manchester, Manchester, United Kingdom.
authors.forename: Iain
authors.initials: I
authors.lastname: Buchan
authors.affiliation: The James Cook University Hospital, Marton Road, Middlesbrough, United Kingdom.
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Ludman
authors.affiliation: University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom.
authors.forename: Jim
authors.initials: J
authors.lastname: Nolan
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016016:Proportional Hazards Models; D017534:Radial Artery; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome; D006113:United Kingdom