Transradial intervention for patients with ST elevation myocardial infarction with or without cardiogenic shock

Fujii, Toshiharu; Masuda, Naoki; Ijichi, Takeshi; Kamiyama, Yoshinari; Tanaka, Shigemitsu; Nakazawa, Gaku; Shinozaki, Norihiko; Matsukage, Takashi; Ogata, Nobuhiko; Ikari, Yuji

doi:10.1002/ccd.24896

Cited by 9 publications

(7 citation statements)

References 30 publications

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“…This is probably a consequence of their definition of CS, with a blood pressure threshold <100 mmHg rather than the <90 mmHg usually used in other studies. Our procedural success rate of 70.3% is broadly similar to previous series in CS [13,14,16], with the exception of one study that reported an impressive success rate of 95.3% [15].…”

Section: Discussionsupporting

confidence: 90%

“…This may be explained by the 70% radial access rate and the use of smaller diameter sheaths (5F and 6F) in our centre. Two other studies reported a lower rate of major bleeding [14,16]. However, under-reporting of bleeding complications is a common bias: outcome data were not available for 10% of the cohort in one study [16], and no precise definition of bleeding was provided in another study [14].…”

Section: Discussionmentioning

confidence: 95%

“…However, most of these trials excluded patients with CS. So far, studies focusing on transradial access for PCI in CS patients are scarce [13][14][15][16][17]. Reported rates of radial approach in such studies range from 26-70% of all procedures.…”

Section: Discussionmentioning

confidence: 99%

“…2) [13][14][15][16][17]. Mortality data were collected at 30 days for all studies except one [17], where only in-hospital mortality was reported.…”

Section: Meta-analysismentioning

confidence: 99%

“…Major bleeding and transfusion data were collected during hospital stay, except in one study [15] where major bleeding (but not transfusion) was reported at 30 days. Major bleeding complications were defined according to the TIMI haemorrhage classification [13] or study-specific criteria [14][15][16][17]. Patients' major characteristics and endpoint results are detailed for each study in Table 5.…”

Section: Meta-analysismentioning

confidence: 99%

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Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies

Roule

Lemaître

Sabatier

et al. 2015

Archives of Cardiovascular Diseases

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

“…2) [13][14][15][16][17]. Mortality data were collected at 30 days for all studies except one [17], where only in-hospital mortality was reported.…”

Section: Meta-analysismentioning

confidence: 99%

Section: Meta-analysismentioning

confidence: 99%

See 3 more Smart Citations

Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies

Roule

Lemaître

Sabatier

et al. 2015

Archives of Cardiovascular Diseases

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Comparison of radial to femoral PCI in acute myocardial infarction and cardiogenic shock: a systematic review

Gandhi

Kakar

Overgaard

2014

J Thromb Thrombolysis

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In randomized control trials and meta-analyses in patients with acute MI undergoing PCI, the radial artery (RA) approach compared to the femoral artery (FA) approach has shown to safely reduce access site related bleeding, length of hospitalization, and major adverse cardiac event (MACE) rates. However, these studies have excluded patients with cardiogenic shock. A systematic search was conducted to retrieve studies that investigated the safety of RA to FA PCI in patients with AMI and cardiogenic shock. Primary outcomes of interest was the pooled relative risk ratio (RR) of access site related bleeding. Secondary outcomes included (i) 30-day all cause mortality, (ii) major bleeding, (iii) final TIMI 3 flow, (iv) fluoroscopy time, and (v) amount of contrast volume administered. 6 observational studies with 7,753 patients met inclusion; 5,347 (69 %) with STEMI, 2,406 (31 %) with non-STEMI. In comparison of RA to FA PCI, there was less access site related bleeding (relative risk (RR) 0.11, p = 0.001), less 30-day mortality (RR 0.65, p = 0.0 < 0.001), and less major bleeding (RR of 0.46 p < 0.0001). There was no significant difference in final TIMI 3 flow (p = 0.27), fluoroscopy time (p = 0.95), and contrast volume administered (p = 0.59). In conclution, despite its limitations, our analysis demonstrates an association towards lower adverse events in the RA PCI group. Although we believe that the choice of access site in a high-risk setting should be at the operator discretion, if technically feasible, the RA appears to be a reasonable vascular access approach in high-risk patients in cardiogenic shock.

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Transradial Intervention in ST Elevation Myocardial Infarction

et al. 2015

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Primary percutaneous coronary intervention (PPCI) in ST elevation myocardial infarction (STEMI) represents the current gold standard reperfusion therapy. Recent advances in antiplatelet and anticoagulant therapy have reduced the risk of ischemic complications and mortality in PPCI although this has been at the expense of major bleeding complications. Access site-related bleeding complications account for up to 50 % of major peri-procedural bleeding complications in PCI. Increasing adoption of the radial artery as the default access site has been shown to markedly reduce such major bleeding complications and mortality in selected patient cohorts. Recent data has suggested that adoption of the transradial access site in STEMI PCI procedures is associated with significant reductions in major bleeding complications and mortality in both national registry data and randomised controlled trials. We provide an overview of this data and discuss the remaining uncertainties around the synergy between access site and contemporary antithrombotic and antiplatelet therapy in such patients. Finally, whilst adoption of the radial artery as the default access site in PPCI has yielded a similar reduction in mortality as observed in the switch from thrombolysis to PPCI in the past, its adoption as a default access site is not universal. We discuss the remaining obstacles and challenges for more widespread adoption of the radial access site as the default access site in PPCI.

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Transradial intervention for patients with ST elevation myocardial infarction with or without cardiogenic shock

Abstract: In TRI high volume center, TRI for STEMI was safe and feasible as a default approach. TRI could be applied to severe shock patients with similar clinical outcome to TFI.

Cited by 9 publications

References 30 publications

Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies

Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies

Comparison of radial to femoral PCI in acute myocardial infarction and cardiogenic shock: a systematic review

Transradial Intervention in ST Elevation Myocardial Infarction

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