Radial versus femoral artery access for percutaneous coronary artery intervention in patients with acute myocardial infarction and multivessel disease complicated by cardiogenic shock: Subanalysis from the CULPRIT-SHOCK trial

Structured abstract Background The use and 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 by cardiogenic shock (CS) remains unclear. Methods This is a post-hoc analysis of the CULPRIT-SHOCK trial where patients presenting with MI and multivessel disease complicated by CS were randomized to a strategy of culprit-lesion-only or immediate multivessel PCI. Arterial access was left at operator's discretion. Adjudicated outcomes of interest were the composite of death or renal-replacement therapy (RRT) at 30-day and one-year. Multivariate logistic models were used to assess the association between the arterial access and outcomes. Results Among the 673 analyzed patients, TRA and TFA were 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; aOR: 0.56; 95%CI 0.33–0.96) and RRT (5.9% vs. 15.9%; aOR: 0.40; 95%CI 0.16–0.97). No significant differences were observed regarding the 30-day risks of type 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%; aOR: 0.85; 95%CI 0.50–1.45 and 42.4% vs. 55.5%, aOR: 0.78; 95%CI 0.46–1.32, respectively). Conclusions In patients undergoing PCI for acute MI complicated by CS, TRA may be associated with improved early outcomes, while the reason for this finding needs further research.