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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
- Source :
- American heart journal. 165(3)
- Publication Year :
- 2012
-
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. Methods and 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 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). Conclusion 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.
- Subjects :
- Male
medicine.medical_specialty
Percutaneous
medicine.medical_treatment
Myocardial Infarction
Shock, Cardiogenic
Femoral artery
Postoperative Hemorrhage
Percutaneous Coronary Intervention
medicine.artery
Internal medicine
medicine
Humans
Myocardial infarction
Radial artery
Aged
business.industry
Cardiogenic shock
Hazard ratio
Percutaneous coronary intervention
Middle Aged
medicine.disease
Survival Analysis
Femoral Artery
Treatment Outcome
Conventional PCI
Radial Artery
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 10976744
- Volume :
- 165
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- American heart journal
- Accession number :
- edsair.doi.dedup.....bf933598b7741423881f9707bd0f06c8