Transradial versus transfemoral coronary intervention for acute myocardial infarction complicated by cardiogenic shock: is transradial coronary intervention suitable for emergency PCI in high-risk acute myocardial infarction?

Background. Data are limited regarding the clinical results of transradial coronary intervention (TRI) in acute myocar-, dial infarction (AMI) complicated by cardiogenic shock. Objective. The aim of this study was to compare the clinical results of TM and transfemoral coronary intervention (TFI) in AMI patients who had cardiogenic shock and underwent emergency percutaneous coronary intervention (PCI). Methods. Between January 1, 2006, and August 31, 2012, a total of 507 consecutive patients with AMI underwent emergency PCI within 12 hours of onset. Eighty-five patients presented with cardiogenic shock and were enrolled. Among these patients, 60 underwent TM and 25 underwent TFI. Outcome measures included the following: major bleeding and vascular complications; major adverse cardiac or cerebrovascular events (MACCE); all-cause death; door-to-balloon time; and PCI procedural success. Results. TM had a significantly lower rate of major bleeding and vascular complications within 30 days (6.7% vs 28.0%; P<.05) and 1 year (log-rank P=.05) than TFI. No significant differences were observed between the two groups in the MACCE rate within 30 days (28.3% vs 44.0%; P=.21) and 1 year (log-rank P=.06), and the all-cause death rate within 30 days (26.7% vs 40.0%; P=.30) and 1 year (log-rank P=.09). In addition, TM was not inferior to TFI in terms of door-to-balloon time (99.8 min vs 110.4 min; P=.30) and PCI procedural success (95.0% vs 96.0%; P>.99). Conclusion. TM is associated with fewer major bleeding and vascular complications than TFI, and it appears suitable for both low- and high-risk AIVII patients, especially when AMI is complicated by cardiogenic shock.