Reference : Arterial access site utilization in cardiogenic shock in the United Kingdom: is radia...
Scientific journals : Article
Human health sciences : Cardiovascular & respiratory systems
http://hdl.handle.net/10993/27662
Arterial access site utilization in cardiogenic shock in the United Kingdom: is radial access feasible?
English
Mamas, Mamas A. [> >]
Anderson, Simon G. [> >]
Ratib, Karim [> >]
Routledge, Helen [> >]
Neyses, Ludwig mailto [University of Luxembourg > Rectorate > Research Service]
Fraser, Douglas G. [> >]
Buchan, Iain [> >]
de Belder, Mark A. [> >]
Ludman, Peter [> >]
Nolan, Jim [> >]
2014
American heart journal
167
6
900-8.e1
Yes (verified by ORBilu)
0002-8703
1097-6744
United States
[en] Aged ; Cohort Studies ; Female ; Femoral Artery ; Great Britain ; Hemorrhage/epidemiology ; Hospital Mortality ; Humans ; Male ; Multivariate Analysis ; Myocardial Infarction/complications/mortality/therapy ; Percutaneous Coronary Intervention/methods ; Proportional Hazards Models ; Radial Artery ; Retrospective Studies ; Shock, Cardiogenic/etiology/mortality/therapy ; Stroke/epidemiology ; Treatment Outcome
[en] BACKGROUND: Cardiogenic shock (CS) remains the leading cause of mortality in patients hospitalized with acute myocardial infarction (AMI). The transradial access site (TRA) has become increasingly adopted as a default access site for percutaneous coronary intervention (PCI); however, even in experienced centers that favor the radial artery as the primary access site during PCI, patients presenting in CS are often treated via the transfemoral access site (TFA); and commentators have suggested that CS remains the final frontier that has given even experienced radial operators pause. We studied the use of TRA in patients presenting in CS in a nonselected high-risk cohort from the British Cardiovascular Intervention database over a 7-year period (2006-2012). METHODS: Mortality (30-day) and major adverse cardiac and cerebrovascular events (a composite of in-hospital mortality, in-hospital myocardial reinfarction, target vessel revascularization, and cerebrovascular events) were studied based on TFA and TRA utilization in CS patients. The influence of access site selection was studied in 7,231 CS patients; TFA was used in 5,354 and TRA in 1,877 patients. RESULTS: Transradial access site was independently associated with a lower 30-day mortality (hazard ratio [HR] 0.56, 95% CI 0.46-0.69, P = 0 < .001), in-hospital major adverse cardiac and cerebrovascular events (HR 0.64, 95% CI 0.53-0.76, P < .0001) and major bleeding (HR 0.37, 95% CI 0.18-0.73, P = .004). CONCLUSIONS: Although the majority of PCI cases performed in patients with cardiogenic shock in the United Kingdom are performed through the TFA, the radial artery represents an alternative viable access site in this high-risk cohort of patients in experienced centers.
http://hdl.handle.net/10993/27662
Copyright (c) 2014 Mosby, Inc. All rights reserved.

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