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Cohort study

Outcomes and Institutional Variation in Arterial Access Among Patients With AMI and Cardiogenic Shock Undergoing Percutaneous Coronary Intervention (PCI)

JACC Cardiovasc IntervPublished

  • Retrospective cohort study
  • registry-based
  • multivariable logistic regression and inverse probability weighting
  • falsification analysis
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Authors' conclusion

TRA-PCI was associated with significantly lower incidence of in-hospital major bleeding, mortality, vascular complications, and new dialysis. This benefit was observed irrespective of mechanical circulatory support use.

Study context

Population
Patients with AMI and cardiogenic shock undergoing PCI, NCDR CathPCI registry, April 2018–June 202125.6% transradial access (TRA)
Participants
35,944 patients
Exposure
Transradial vs transfemoral access for PCI
Outcome
In-hospital outcomes:
  • Major bleeding
  • Mortality
  • Vascular complications
  • New dialysis
Follow-up
In-hospital

Main finding

As reported in the abstract

In-hospital outcomes (adjusted)
TRA vs TFAOdds ratio (95% CI)
major bleeding
0.71(0.67–0.76)
mortality
0.73(0.69–0.78)
vascular complications
0.67(0.54–0.84)
new dialysis
0.86(0.77–0.97)

Observational data: associations, not effects.

Further findings

OutcomeOR (95% CI)
Non-access site related bleeding (falsification analysis)0.93 (0.84–1.03)

Proportion of TRA-PCI over time

Q2 2018
22.0%
Q2 2021
29.1%
P-trend
<0.001

Institutional variation in TRA use

Sites using TRA in <2% of PCIs (low utilization)
20.9%
Sites using TRA in >80% of PCIs (high utilization)
1.9%

Patients without arterial cross-over (sensitivity analysis)

Similar benefit with TRA-PCI

Interaction with mechanical circulatory support

No significant interactions between TRA-PCI with mechanical circulatory support and in-hospital outcomes

Original publication

Outcomes and Institutional Variation in Arterial Access Among Patients With AMI and Cardiogenic Shock Undergoing PCI. JACC Cardiovasc Interv. Published 26 June 2023. doi:10.1016/j.jcin.2023.03.043
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Summarised from the published abstract; every number is checked against it