Acute cardiac care & resuscitation
Femoral vs. radial approach for primary percutaneous intervention in cardiogenic shock: a subanalysis from the ECLS-SHOCK trial
Main finding · 30-day mortalityResult — go to the resultRelative risk 1.37 95% CI 1.06–1.78Authors' conclusion
In myocardial infarction-related CS, nearly one-fifth of patients with intended radial access switched to femoral. In multivariate analysis, femoral access was associated with a trend to adversely affect 30-day mortality.
Study context
- Population
- Patients with infarct-related cardiogenic shock treated with or without extracorporeal life support (ECLS)
- Participants
- 415 patients
- Comparison
- Femoral vs. radial approach for primary percutaneous intervention
- Femoraln = 304
- Radialn = 111reference
- Outcome
- 30-day mortality
- Follow-up
- 30 days
Methodological detailsintended access site analysis, actual access site analysis, multivariate analysis
- Intended access site analysis
- Actual access site analysis
- Multivariate analysis
Main finding
As reported in the abstract
Relative risk
1.37
95% CI 1.06–1.78
0.011
By group
Femoral
52.0
%
Radial
37.8%
Femoralvs radial
RR 1.37 (95% CI 1.06–1.78); 0.011
Secondary outcomes
| Outcome | Femoral% | Radial | RR (95% CI) | P value | |
|---|---|---|---|---|---|
| 30-day mortality, ECLS arm (actual access site) | 52.7 | 26.8% | 1.96 (1.16–3.32) | P = 0.003 | |
| 30-day mortality, conservative arm (actual access site) | 52.2 | 37.5% | 1.39 (0.94–2.06) | P = 0.074 | |
| Adjusted 30-day mortality · multivariate analysis; trend | 1.22 (0.95–1.55) | P = 0.11 | |||
| 0.20.5125Relative risk (log scale) |
Access site crossover (intended access site analysis)
- Access site crossover (intended access site analysis): radial group switched to femoral; femoral group switched to radial, prior to or after coronary angiography
Secondary and safety endpoints (crude rates) · 30 days
- No significant differences in the crude rates of secondary and safety endpoints
Radial to femoral switch (actual access site analysis)
- ECLS arm switched from radial to femoral
- 7.8%
- Conservative arm switched from radial to femoral
- 7.5%
Original publication
Femoral vs. radial approach for primary percutaneous intervention in cardiogenic shock: a subanalysis from the ECLS-SHOCK trial. Eur Heart J Acute Cardiovasc Care. Published 5 March 2025. doi:10.
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