0423: Trans-radial approach is associated with reduced mortality as compared to trans-femoral approach in patients admitted for PCI for ischemic- related cardiogenic shock

Abstract

Myocardial infarction (MI)-related cardiogenic shock (CS) remains associated with major mortality rates. Trans-radial approach for percutaneous coronary intervention (PCI) has been associated with better outcome in the setting of MI but patients with CS were excluded. To assess the outcome of MI-related CS in patients treated by trans-radial versus trans-femoral approach. A prospective cohort of 101 consecutive patients admitted for PCI for MI-related CS were treated by trans-radial (n=74) or trans-femoral (n=27) approach. Cox proportional hazards models adjusted on age, gender, GRACE score -CRUSADE score for bleeding-, and need for intra-aortic balloon pump were used to assess mortality, death/MI/Stroke and bleeding between the two groups. Trans-radial approach was associated with lower rates of female gender (p=0.002), younger age (p=0.03), lower GRACE and CRUSADE scores (p=0.002 & 0.001), lower rates of cardiac arrest before PCI (p=0.009) and mechanical ventilation (p=0.006) but similar other demographic variables and need for inotropic support as well as comparable rates of PCI success. At a mean follow-up of 756 days, death occurred in 40 patients (54.1%) in the radial group compared to 22 (81.5%) in the femoral group (p=0.012). Trans-radial approach was associated with significant reductions in death (adjusted HR 0.49 [0.28-0.84]; p=0.01), death/ MI/Stroke (adjusted HR 0.53 [0.31-0.91]; p=0.02) and bleeding (adjusted HR 0.34[0.13-0.87]; p=0.02). Trans-radial approach in the setting of PCI for ischemic CS was associated with a dramatic reduction of mortality, ischemic and bleeding events and should be preferred to trans-femoral approach. Abstract 0423- Figure: Survival curve