title: Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies.
abstract: BACKGROUND
  The transradial approach for percutaneous coronary intervention (PCI) is associated with a better outcome in myocardial infarction (MI), but patients with cardiogenic shock (CS) were excluded from most trials.
  
  
  OBJECTIVE
  To compare outcomes of PCI for MI-related CS via the transradial versus transfemoral approach.
  
  
  METHODS
  A prospective cohort of 101 consecutive patients admitted for PCI for MI-related CS were treated via the transradial (n=74) or transfemoral (n=27) approach. Cox proportional hazards models adjusted for prespecified variables and a propensity score for approach were used to compare mortality, death/MI/stroke and bleeding between the two groups. A complementary meta-analysis of six studies was also performed.
  
  
  RESULTS
  Patients in the transradial group were younger (P=0.039), more often male (P=0.002) and had lower GRACE and CRUSADE scores (P=0.003 and 0.001, respectively) and rates of cardiac arrest before PCI (P=0.009) and mechanical ventilation (P=0.006). Rates of PCI success were similar. At a mean follow-up of 756 days, death occurred in 40 (54.1%) patients in the transradial group versus 22 (81.5%) in the transfemoral group (adjusted hazard ratio [HR]: 0.49, 95% confidence interval [CI] 0.28-0.84; P=0.012). The transradial approach was associated with reduced rates of death/MI/stroke (adjusted HR: 0.53, 95%CI: 0.31-0.91; P=0.02) and major bleeding (adjusted HR: 0.34, 95%CI: 0.13-0.87; P=0.02). The meta-analysis confirmed the benefit of transradial access in terms of mortality (relative risk [RR]: 0.63, 95%CI: 0.58-0.68) and major bleeding (RR: 0.43, 95%CI: 0.32-0.59).
  
  
  CONCLUSIONS
  The transradial approach in the setting of PCI for ischaemic CS is associated with a dramatic reduction in mortality, ischaemic and bleeding events, and should be preferred to the transfemoral approach in radial expert centres.
authors.affiliation: Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Roule
authors.affiliation: Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Lemaitre
authors.affiliation: Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Sabatier
authors.affiliation: Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France.
authors.forename: Thérèse
authors.initials: T
authors.lastname: Lognoné
authors.affiliation: Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Dahdouh
authors.affiliation: Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Berger
authors.affiliation: Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Milliez
authors.affiliation: Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Grollier
authors.affiliation: ACTION academic group, Institut de Cardiologie, Pitié-Salpêtrière University Hospital, 75013 Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.affiliation: Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France; ACTION academic group, Institut de Cardiologie, Pitié-Salpêtrière University Hospital, 75013 Paris, France. Electronic address: beygui-f@chu-caen.fr.
authors.forename: Farzin
authors.initials: F
authors.lastname: Beygui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017534:Radial Artery; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
keywords: Accès vasculaire; Cardiogenic shock; Choc cardiogénique; Death; Décès; Major bleeding; Saignement majeur; Transradial access; Vascular access; Voie radiale