Transradial Access vs. Transfemoral Access for Primary PCI in ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock: Findings from a National, Multicenter Registry and Meta-Analysis.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Korean Circulation Journal Pub Date : 2026-03-11 DOI:10.4070/kcj.2025.0251

Minghui Zhang, Zixu Zhao, Yu Liu, Haoran Ma, Kexin Wang, Tian Liu, Wangyang Yang, Yichen Zhao, Wei Luo, Xuedong Zhao, Keyang Zheng, Chengqian Yin, Xinyong Zhang, Hai Gao, Can Zhou, Dong Zhao

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引用次数: 0

Abstract

Background and objectives: Transradial access (TRA) is recommended for percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) due to lower mortality and bleeding risk, but evidence in STEMI with cardiogenic shock (STEMI-CS) remains limited. To evaluate the efficacy and safety of TRA versus transfemoral access (TFA) for primary PCI in STEMI-CS.

Methods: Using data from a nationwide, multicenter registry, we compared TRA and TFA with multivariable-adjusted Cox regression, propensity score matching, and inverse probability treatment weighting. The primary outcome was in-hospital all-cause mortality. Other outcomes included major bleeding and major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, cardiac arrest, reinfarction, stroke, or in-stent thrombosis. A meta-analysis was conducted to compare short-term outcomes of interest during hospitalization or within 30 days of hospital discharge.

Results: Among 837 eligible patients, 669 underwent TRA. Multivariable Cox regression showed that TRA was associated with a lower risk of in-hospital mortality (adjusted hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.42-0.91), MACE (adjusted HR, 0.63; 95% CI, 0.43-0.91), but a non-significantly lower risk of major bleeding (adjusted HR, 0.72; 95% CI, 0.35-1.49) compared to TFA. Meta-analysis of 65,943 patients from 17 studies confirmed lower short-term mortality (odds ratio [OR], 0.50; 95% CI, 0.43-0.57), major bleeding (OR, 0.58; 95% CI, 0.48-0.71), and MACE (OR, 0.65; 95% CI, 0.53-0.80) with TRA.

Conclusions: Our findings indicate that, in STEMI-CS, TRA is associated with lower short-term all-cause mortality compared with TFA, supporting the potential advantages of TRA in this population.

Trial registration: ClinicalTrials.gov Identifier: NCT02306616.

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经桡动脉入路与经股动脉入路对st段抬高型心肌梗死合并心源性休克的初步PCI：来自国家、多中心登记和荟萃分析的结果

背景和目的：由于死亡率和出血风险较低，经桡动脉通路（TRA）被推荐用于st段抬高型心肌梗死（STEMI）的经皮冠状动脉介入治疗（PCI），但STEMI合并心源性休克（STEMI- cs）的证据仍然有限。评估TRA与经股通道（TFA）在STEMI-CS中进行初级PCI的疗效和安全性。方法：使用来自全国多中心注册中心的数据，我们将TRA和TFA与多变量校正Cox回归、倾向评分匹配和逆概率处理加权进行比较。主要终点是院内全因死亡率。其他结局包括大出血和主要不良心血管事件（MACE），定义为全因死亡率、心脏骤停、再梗死、中风或支架内血栓形成的综合结果。进行了一项荟萃分析，比较住院期间或出院30天内的短期结果。结果：在837例符合条件的患者中，669例接受了TRA治疗。多变量Cox回归显示，与TFA相比，TRA与较低的院内死亡风险（校正风险比[HR]， 0.62； 95%可信区间[CI]， 0.42-0.91）、MACE（校正风险比，0.63;95% CI, 0.43-0.91）相关，但大出血风险（校正风险比，0.72;95% CI, 0.35-1.49）无显著降低。来自17项研究的65,943例患者的荟萃分析证实，TRA降低了短期死亡率（优势比[OR]， 0.50; 95% CI, 0.43-0.57）、大出血（OR, 0.58; 95% CI, 0.48-0.71）和MACE （OR, 0.65; 95% CI, 0.53-0.80）。结论：我们的研究结果表明，在STEMI-CS中，与TFA相比，TRA与较低的短期全因死亡率相关，支持TRA在该人群中的潜在优势。试验注册：ClinicalTrials.gov标识符：NCT02306616。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Korean Circulation Journal CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.90

自引率

17.20%

发文量

103

期刊介绍： Korean Circulation Journal is the official journal of the Korean Society of Cardiology, the Korean Pediatric Heart Society, the Korean Society of Interventional Cardiology, and the Korean Society of Heart Failure. Abbreviated title is ''Korean Circ J''. Korean Circulation Journal, established in 1971, is a professional, peer-reviewed journal covering all aspects of cardiovascular medicine, including original articles of basic research and clinical findings, review articles, editorials, images in cardiovascular medicine, and letters to the editor. Korean Circulation Journal is published monthly in English and publishes scientific and state-of-the-art clinical articles aimed at improving human health in general and contributing to the treatment and prevention of cardiovascular diseases in particular. The journal is published on the official website (https://e-kcj.org). It is indexed in PubMed, PubMed Central, Science Citation Index Expanded (SCIE, Web of Science), Scopus, EMBASE, Chemical Abstracts Service (CAS), Google Scholar, KoreaMed, KoreaMed Synapse and KoMCI, and easily available to wide international researchers