Radial versus femoral access for percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: Trial sequential analysis

Saleem, Maryam; Osman, Khansa; Kheiri, Babikir; Regner, Sean; Radaideh, Qais; Moreland, Jason; Rao, Sunil V.; Kapadia, Samir

doi:10.1016/j.ahj.2020.03.014

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…18 Although bleeding can be mitigated using the radial approach, in women, higher cross-over rates to the femoral approach have been noted which may contribute to the higher bleeding rates in women versus men. [19][20][21]…”

Section: Discussionmentioning

confidence: 99%

“…Second, women tend to have higher vascular complications from access site due to differences in the anatomy and the smaller size of ilio‐femoral arteries in women than men 18 . Although bleeding can be mitigated using the radial approach, in women, higher cross‐over rates to the femoral approach have been noted which may contribute to the higher bleeding rates in women versus men 19‐21 …”

Section: Discussionmentioning

confidence: 99%

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Gender‐based outcomes of coronary bifurcation stenting: A report from the National Readmission Database

Ghaffar

Osman

Kheiri

et al. 2021

Cathet Cardio Intervent

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Background: There is a paucity of data focusing on women's outcomes after percutaneous coronary interventions (PCI) for coronary bifurcation lesions (CBLs).Methods: Patients who received PCI for CBLs in the context of acute coronary syndrome (ACS) during the period of 01 October 2015-31 December 2017, were identified from the United States National Readmission Database. The primary endpoint of this study was in-hospital major adverse events (MAEs). The secondary endpoints were in-hospital mortality, vascular complications, major bleeding, post-procedural bleeding, need for blood transfusion, severe disability surrogates (non-home discharge and need for mechanical ventilation), resources utilization surrogates (length of stay and cost of hospitalization), and 30-day readmission rate. A 1:1 propensity score matching was used to compare the outcomes between women and men.Results: A total of 25,050 (women = 7,480; men = 17,570) patients were included in the current analysis. After propensity score matching, women had higher in-hospital MAEs (7 vs 5.2%, p < .01), major bleeding (1.8 vs 0.8%, p < .01), post-procedural bleeding (6.1 vs 3.4%, p < .01), need for blood transfusion (6.4 vs 4.2%, p < .01), non-home discharges (10.2 vs 7.1%; p < .01), longer length of hospital stay (3 days [IQR 2-6] vs. 3 days [IQR 2-5], p < .01) and higher 30-day readmission rate compared to men (14.2 vs. 11.5%, p < .01).Conclusions: Among all-comers who received PCI for CBLs in the context of ACS, women suffered higher MAEs and 30-day readmission rates compared to their men' counterparts. The higher MAEs in the women were mainly driven by higher postprocedural bleeding rates and the need for blood transfusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gender‐based outcomes of coronary bifurcation stenting: A report from the National Readmission Database

Ghaffar

Osman

Kheiri

et al. 2021

Cathet Cardio Intervent

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“…For patients at risk for shock, it may be reasonable to pursue culprit vessel percutaneous coronary intervention (PCI) via the radial approach because randomized data suggest that radial access decreases bleeding complications and may reduce mortality in the ST-segment-elevation myocardial infarction setting. [53][54][55][56] However, patients with objective evidence of CS within the AMI-CS context should be considered for an initial femoral access strategy that provides a rapid route for escalation to tMCS if required. In patients with AMI at risk for shock, an LV end-diastolic pressure should be obtained to provide rapid evaluation of left-sided filling pressures.…”

Section: Escalation Of Tmcs In Patients With Ami-csmentioning

confidence: 99%

Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association

Geller¹,

Sinha²,

Kapur³

et al. 2022

Circulation

109

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The use of temporary mechanical circulatory support in cardiogenic shock has increased dramatically despite a lack of randomized controlled trials or evidence guiding clinical decision-making. Recommendations from professional societies on temporary mechanical circulatory support escalation and de-escalation are limited. This scientific statement provides pragmatic suggestions on temporary mechanical circulatory support device selection, escalation, and weaning strategies in patients with common cardiogenic shock causes such as acute decompensated heart failure and acute myocardial infarction. The goal of this scientific statement is to serve as a resource for clinicians making temporary mechanical circulatory support management decisions and to propose standardized approaches for their use until more robust randomized clinical data are available.

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“…In the present study, trans-radial access and the use of mechanical support were significantly associated with MACE. Previous studies showed that trans-radial primary PCI was associated with less bleeding and long-term clinical outcomes [32][33][34]. However, we should mention the presence of selection bias regarding the access site.…”

Section: Plos Onementioning

confidence: 87%

Factors associated with poor clinical outcomes of ST-elevation myocardial infarction in patients with door-to-balloon time <90 minutes

et al. 2020

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Background Recent guidelines for ST-elevation myocardial infarction (STEMI) recommended the doorto-balloon time (DTBT) <90 minutes. However, some patients could have poor clinical outcomes in spite of DTBT <90 minutes, which suggest the importance of therapeutic targets except DTBT. The purpose of this study was to find factors associated with poor clinical outcomes in STEMI patients with DTBT <90 minutes. Methods This retrospective study included 383 STEMI patients with DTBT <90 minutes. The primary endpoint was the major adverse cardiac events (MACE) defined as the composite of allcause death, acute myocardial infarction, and acute heart failure requiring hospitalization. Result The median follow-up duration was 281 days, and the cumulative incidence of MACE was 16.2%. In the multivariate Cox hazard model, low body mass index (< 20 kg/m 2) (vs. >20 kg/ m 2 : HR 2.80, 95% CI 1.39-5.64, p = 0.004), history of previous myocardial infarction (HR 2.39, 95% CI 1.06-5.37, p = 0.04), and Killip class 3 or 4 (vs. Killip class 1 or 2: HR 2.39, 95% CI 1.30-4.40, p = 0.005) were significantly associated with MACE. In another multivariate Cox hazard model, flow worsening during percutaneous coronary intervention (PCI) (HR 3.24, 95% CI 1.79-5.86, p<0.001) and use of mechanical support (HR 3.15, 95% CI 1.71-5.79, p<0.001) were significantly associated with MACE, whereas radial approach (HR 0.54, 95% CI 0.32-0.92, p = 0.02) was inversely associated with MACE. Conclusion Low body mass index, Killip class 3/4, history of previous myocardial infarction, use of mechanical support, and flow worsening were significantly associated with MACE, whereas

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Radial versus femoral access for percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: Trial sequential analysis

Cited by 8 publications

References 17 publications

Gender‐based outcomes of coronary bifurcation stenting: A report from the National Readmission Database

Gender‐based outcomes of coronary bifurcation stenting: A report from the National Readmission Database

Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association

Factors associated with poor clinical outcomes of ST-elevation myocardial infarction in patients with door-to-balloon time <90 minutes

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