Matthias Hasun1, Jakob Dörler2, Hannes F Alber3, Axel Bauer2, Rudolf Berger4, Günter Christ5, Matthias Frick6, Uta C Hoppe7, Kurt Huber8, Gudrun Lamm9, Elisabeth Laßnig10, Dirk von Lewinski11, Anna Rab12, Franz X Roithinger13, Herwig Schuchlenz14, Peter Siostrzonek15, Johann Sipötz16, Thomas Stefenelli17, Clemens Steinwender18, Michael Edlinger19,20, Franz Weidinger1. 1. 2nd Medical Department with Cardiology and Intensive Care Medicine, KA Rudolfstiftung, Vienna, Austria. 2. Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria. 3. Department of Internal Medicine and Cardiology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria. 4. Department of Internal Medicine I, Cardiology and Nephrology, Krankenhaus der Barmherzigen Brüder Eisenstadt, Eisenstadt, Austria. 5. 5th Medical Department with Cardiology, Sozialmedizinisches Zentrum Süd - Kaiser Franz Josef Hospital, Vienna, Austria. 6. 1st Department of Internal Medicine, Landeskrankenhaus Feldkirch, Feldkirch, Austria. 7. Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria. 8. 3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenspital, and Medical School, Sigmund Freud University, Vienna, Austria. 9. Department of Internal Medicine III, Universitätsklinikum St. Pölten, St. Pölten, Austria. 10. Department of Internal Medicine II, Cardiology and Intensive Care Medicine, Klinikum Wels-Grieskirchen, Wels, Austria. 11. Department of Internal Medicine, Cardiology, Medical University Graz, Graz, Austria. 12. Department for Internal Medicine, Landeskrankenhaus Villach, Villach, Austria. 13. Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria. 14. Department of Internal Medicine, Cardiology and Intensive Care Medicine, Landeskrankenhaus Graz West, Graz, Austria. 15. Department of Internal Medicine II - Cardiology, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria. 16. 2nd Department of Internal Medicine, Hanusch Hospital, Vienna, Austria. 17. Department of Internal Medicine I, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria. 18. Department of Internal Medicine I, Cardiology and Internal Intensive Medicine, Kepler Universitätsklinikum, Linz, Austria. 19. Department of Medical Statistics, Informatics, and Health Economics, Medical University Innsbruck, Innsbruck, Austria. 20. Department of Development and Regeneration, KU Leuven, Belgium.
Abstract
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. 2021 Cardiovascular Diagnosis and Therapy. All rights reserved.
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. 2021 Cardiovascular Diagnosis and Therapy. All rights reserved.
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