Characteristics and outcome in cardiogenic shock according to vascular access site for percutaneous coronary intervention.

IF 3.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal: Acute Cardiovascular Care Pub Date : 2024-08-28 DOI:10.1093/ehjacc/zuae078
Elma J Peters, Margriet Bogerd, Sanne Ten Berg, Marijke J C Timmermans, Annemarie E Engström, Holger Thiele, Christian Jung, Benedikt Schrage, Krischan D Sjauw, Niels J W Verouden, Koen Teeuwen, Admir Dedic, Martijn Meuwissen, Peter W Danse, Bimmer E P M Claessen, José P S Henriques
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Abstract

Aims: The optimal vascular access site for percutaneous coronary interventions (PCIs) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains uncertain. While observational data favour transradial access (TRA) due to lower complication rates and mortality, transfemoral access (TFA) PCI offers advantages such as shorter access and procedure times, along with quicker escalation to mechanical circulatory support (MCS). In this study, we aimed to investigate factors associated with a transfemoral approach and compare mortality rates between TRA and TFA in AMI-CS patients undergoing PCI.

Methods and results: Data from a nationwide registry of AMI-CS patients undergoing PCI (2017-2021) were analysed. We compared patient demographics, procedural details, and outcomes between TRA and TFA groups. Logistic regression identified access site factors and radial-to-femoral crossover predictors. Propensity score-matched (PSM) analysis examined the impact of access site on mortality. Of the 1562 patients, 45% underwent TRA PCI, with an increasing trend over time. Transfemoral access patients were more often female, had a history of coronary artery bypass grafting, lower blood pressure, higher resuscitation and intubation rates, and elevated lactate levels. After PSM, 30-day mortality was lower in TRA (33% vs. 46%, P < 0.001). Predictors for crossover included left coronary artery interventions, multivessel PCI, and MCS initiation.

Conclusion: Significant differences exist between TRA and TFA PCI in AMI-CS. Transfemoral access was more common in patients with worse haemodynamics and was associated with higher 30-day mortality compared with TRA. This mortality difference persisted in the PSM analysis.

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心源性休克的特征和预后取决于 PCI 的血管通路部位。
背景:急性心肌梗死(AMI)并发心源性休克(CS)患者经皮冠状动脉介入治疗(PCI)的最佳血管通路部位仍不确定。虽然观察数据显示经桡动脉入路(TRA)并发症发生率和死亡率较低,但经股动脉(TFA)PCI 具有入路和手术时间短、更快升级为机械循环支持(MCS)等优势。在这项研究中,我们旨在调查经股动脉入路的相关因素,并比较接受PCI的AMI-CS患者中TRA和TFA的死亡率:我们分析了接受 PCI 治疗的 AMI-CS 患者的全国性登记数据(2017-2021 年)。我们比较了 TRA 组和 TFA 组患者的人口统计学特征、手术细节和结果。逻辑回归确定了入路部位因素和桡骨-股骨交叉预测因素。倾向评分匹配(PSM)分析检验了入路部位对死亡率的影响:在1562名患者中,45%接受了TRA PCI,且随着时间的推移呈上升趋势。TFA患者多为女性,有冠状动脉旁路移植术(CABG)病史,血压较低,复苏率和插管率较高,乳酸水平升高。在 PSM 之后,TRA 患者的 30 天死亡率较低(33% 对 46%,P 结论:TRA 和 CABG 患者之间存在显著差异:在 AMI-CS 中,TRA 和 TFA PCI 之间存在显著差异。与 TRA 相比,TFA 更常见于血流动力学较差的患者,且 30 天死亡率较高。这种死亡率差异在倾向评分匹配分析中依然存在。
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来源期刊
CiteScore
8.50
自引率
4.90%
发文量
325
期刊介绍: The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes. Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.
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