https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Mannheim GmbH I. Medizinische Klinik Mannheim, Deutschland; 2Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; 3Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland; 4Asklepios Klinik Langen Medizinische Klinik I, Kardiologie und Angiologie Langen, Deutschland; 5Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland; 6Charité - Universitätsmedizin Berlin CC 11: Med. Klinik für Kardiologie Berlin, Deutschland; 7Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 8SLK-Kliniken Heilbronn GmbH, Klinikum am Gesundbrunnen Klinik für Innere Medizin I Heilbronn, Deutschland; 9Elisabeth-Krankenhaus Essen GmbH Klinik für Akut- und Notfallmedizin Essen, Deutschland; 10Herzzentrum Dresden GmbH an der TU Dresden Klinik für Innere Medizin, Kardiologie und Intensivmedizin Dresden, Deutschland; 11Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland; 12Universitätsklinikum Würzburg Medizinische Klinik und Poliklinik I Würzburg, Deutschland; 13Universitätsklinikum Düsseldorf Klinik für Kardiologie, Pneumologie und Angiologie Düsseldorf, Deutschland; 14Zentralklinik Bad Berka GmbH Klinik für Kardiologie und Internistische Intensivmedizin Bad Berka, Deutschland; 15Klinikum der Stadt Ludwigshafen gGmbH Medizinische Klinik B Ludwigshafen am Rhein, Deutschland
Background
Cardiogenic shock (CS) is a life-threatening complication of acute coronary syndromes (ACS). Early revascularization with treating the culprit lesion improves survival. Nevertheless, the impact of access site (femoral vs. radial) on outcomes in infarct-related CS also in conjunction with extracorporeal life support (ECLS) remains unclear.
Methods
This subanalysis of the ECLS-SHOCK trial included patients with infarct-related CS treated with or without ECLS, divided into femoral and radial access groups. The primary endpoint was 30-day mortality. Secondary endpoints included renal replacement therapy (RRT), repeat revascularization, reinfarction, rehospitalization for congestive heart failure, and poor neurological outcome (Cerebral Performance Category [CPC] 3-5) within 30 days. Safety outcomes included bleeding and peripheral vascular complications.
Results
Among 415 patients, percutaneous coronary intervention (PCI) was initially intended through femoral (N=304; 72.9%) or radial (N=111; 26.6%) access. In the radial group, 25 patients (22.5%) switched to femoral access, while 3 patients (1%) in the femoral group switched to radial access prior to or after coronary angiography. At 30 days, the overall mortality rate was higher in the femoral group compared to the radial group (52.0% vs. 37.8%) with a relative risk (RR) of 1.37; 95%-confidence interval [CI], 1.06-1.78; p=0.011 with no significant differences in the crude rates of secondary and safety endpoint. In the as-treated ECLS arm, 7.8% switched from radial to femoral, while 7.5% switched in the as-treated conservative arm from radial to femoral for or after coronary angiography. Mortality rates were higher in the femoral group for both ECLS (52.7% vs. 26.8%; p=0.003; RR 1.96 [95% CI, 1.16-3.32]) and conservative arms (52.2% vs. 37.5%; p=0.074; RR 1.39 [95% CI, 0.94-2.06]). In a multivariate analysis, femoral access was associated with a strong trend for predicting adjusted 30-day mortality (RR, 1.69; 95% CI, 0.99-2.86; p=0.051).
Conclusions
In myocardial infarction related CS, nearly one-fifth of patient’s with intended radial access switched to femoral, which was associated with a higher mortality but similar safety outcomes regardless of ECLS or conservative treatment by univariate analysis. In multivariate analysis, femoral access was associated with a trend to adversely affect 30-day mortality.