Résumé
IntroductionThe impact of transradial artery access (TRA) compared to transfemoral artery access (TFA) in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) complicated with cardiogenic shock (CS) remains unclear.ObjectiveTo assess the impact of TRA and TFA on early and late outcomes in this setting.MethodsThe CULPRIT-SHOCK trial randomized patients presenting with MI and multivessel disease complicated by CS to a culprit-lesion-only or immediate multivessel PCI strategy. Arterial access was left at the operator’s discretion. Adjudicated outcomes of interest were the composite of death or renal-replacement therapy (RRT) at 30-day and one-year. Multivariate logistics models were used to assess the association between the arterial access and outcomes.ResultsAmong the 673 analyzed patients, TRA and TFA was successfully performed in 118 (17.5%) and 555 (82.5%) patients, respectively. TRA was associated with lower 30-day rate of death or RRT compared to TFA (37.3% vs. 53.2%, respectively, adjusted Odds Ratio [aOR]0.57; 95% confidence interval [CI] 0.34-0.96), lower 30-day rates of death (34.7% vs. 49.7%, respectively; aOR0.56; 95%CI 0.33-0.96) (Figure 1) and RRT (5.9% vs. 15.9%; aOR0.40; 95%CI 0.16-0.97). No significant differences were observed regarding the 30-day risks of type 2, 3 or 5 BARC bleeding and stroke. The observed reduction of death or RRT and death with TRA was no longer significant at one-year (44.9% vs 57.8%; aOR0.81; 95%CI 0.48-1.37 and 42.4% vs. 55.5%, aOR0.74; 95%CI 0.44-1.25, respectively).No significant interactions between the PCI strategies (i.e. culprit-lesion-only or multivessel PCI) and arterial accesses were observed for any outcomes.ConclusionsIn patients undergoing PCI for acute MI complicated by CS, TRA may be associated with improved early outcomes.