Transradial Access vs. Transfemoral Access for Primary PCI in ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock: Findings from a National, Multicenter Registry and Meta-Analysis

作者：Minghui Zhang, Zixu Zhao, Yu Liu, Haoran Ma, Kexin Wang, T. C. Liu, Wangyang Yang, Yichen Zhao, Wei Luo, Xuedong Zhao, Keyang Zheng, C. Cameron Yin, Xinyong Zhang, Hai Gao, Can Zhou, Dong Zhao · 发表于：Korean Circulation Journal · 年份：2026 · DOI：10.4070/kcj.2025.0251 · 被引用次数：2 · 研究领域：Vascular Procedures and Complications、Acute Myocardial Infarction Research、Mechanical Circulatory Support Devices

BACKGROUND AND OBJECTIVES: Transradial access (TRA) is recommended for percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) due to lower mortality and bleeding risk, but evidence in STEMI with cardiogenic shock (STEMI-CS) remains limited. To evaluate the efficacy and safety of TRA versus transfemoral access (TFA) for primary PCI in STEMI-CS. METHODS: Using data from a nationwide, multicenter registry, we compared TRA and TFA with multivariable-adjusted Cox regression, propensity score matching, and inverse probability treatment weighting. The primary outcome was in-hospital all-cause mortality. Other outcomes included major bleeding and major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, cardiac arrest, reinfarction, stroke, or in-stent thrombosis. A meta-analysis was conducted to compare short-term outcomes of interest during hospitalization or within 30 days of hospital discharge. RESULTS: Among 837 eligible patients, 669 underwent TRA. Multivariable Cox regression showed that TRA was associated with a lower risk of in-hospital mortality (adjusted hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.42-0.91), MACE (adjusted HR, 0.63; 95% CI, 0.43-0.91), but a non-significantly lower risk of major bleeding (adjusted HR, 0.72; 95% CI, 0.35-1.49) compared to TFA. Meta-analysis of 65,943 patients from 17 studies confirmed lower short-term mortality (odds ratio [OR], 0.50; 95% CI, 0.43-0.57), major blee...