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Radial versus femoral access for coronary angiography in patients with acute myocardial infarction and cardiogenic shock
Session:
Posters 1 - Écran 02 - Cuidados Intensivos
Speaker:
Joana Vieira Simoes
Congress:
CPC 2018
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Posters
FP Number:
---
Authors:
Joana Simões; Frederico Pinto Da Costa; David Cabrita Roque; Miguel Borges Dos Santos; Pedro Farto e Abreu; Carlos Sequeira De Morais
Abstract
<p><strong>BACKGROUND</strong>: Cardiogenic shock complicates 5 to 10% of cases of acute myocardial infarction (MI), and is associated with early mortality of 40 to 50%. Immediate coronary angiography is recommended in patients with acute MI and cardiogenic shock. In patients with acute MI undergoing coronary angiography, previous studies have suggested a lower risk of death with radial than with femoral access.</p> <p><strong>AIM</strong>: To assess whether radial access is superior to femoral access in patients with acute MI and cardiogenic shock undergoing coronary angiography.</p> <p><strong>METHODS</strong>: We conducted a retrospective review of all patients who underwent coronary angiography for acute MI and cardiogenic shock in a single institution along 5 years. Compared outcomes between radial access group and femoral access group were all-cause death within 30 days, 6 months and 12 months, and severe renal failure leading to renal-replacement therapy within 30 days after coronary angiography.</p> <p><strong>RESULTS</strong>: Between January 1, 2012, and December 31, 2016, 167 patients underwent coronary angiography for acute MI and cardiogenic shock. Mean age was 67.5 ± 13.5 years and 69.5% (n=116) were male. Radial access was used in 18.0% (n=30) and femoral access was used in 82.0% (n= 137). All-cause death within 30 days occurred in 6.7% (n=2) of patients in radial access group and 29.9% (n=41) of patients in femoral access group [odds ratio (OR) 0.17, 95% confidence interval (CI) 0.04–0.74, p value=0.008]. All-cause death within 6 months occurred in 6.7% (n=2) of patients in radial access group and 31.4% (n=43) of patients in femoral access group (OR 0.16, 95% CI 0.04–0.69, p value=0.006). All-cause death within 12 months occurred in 6.7% (n=2) of patients in radial access group and 32.8% (n=45) of patients in femoral access group (OR 0.15, 95% CI 0.03–0.64, p value=0.004). Severe renal failure leading to renal-replacement therapy within 30 days occurred in 6.7% (n=2) of patients in radial access group and 21.9% (n=30) of patients in femoral access group (OR 0.25, 95% CI 0.06–1.13, p value=0.054).</p> <p><strong>CONCLUSION</strong>: Among patients with acute MI and cardiogenic shock undergoing coronary angiography, radial access was associated with lower rates of all-cause death within 30 days, 6 months and 12 months, and to lower rates of severe renal failure within 30 days after coronary angiography. Although a radial approach is associated with better outcome, it was choosen in less than one fifth of our patients. Experience and expertise might have limited radial approach in this particularly unstable population with acute MI and cardiogenic shock.</p>
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