Acute cardiac care & resuscitation
Outcomes and Institutional Variation in Arterial Access Among Patients With AMI and Cardiogenic Shock Undergoing Percutaneous Coronary Intervention (PCI)
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
Methodological detailsregistry-based, multivariable logistic regression and inverse probability weighting, falsification analysis
- Registry-based
- Multivariable logistic regression and inverse probability weighting
- Falsification analysis
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
| Outcome | OR (95% CI) | |
|---|---|---|
| Non-access site related bleeding (falsification analysis) | 0.93 (0.84–1.03) | |
| 0.512Odds ratio (log scale) |
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.
Composed by AI from the published abstract and checked against it. How Briefs are made →