Cardiogenic shock and access site choice.

Transradial access (TRA) has increased in utilization, although operators have been reluctant to use TRA in patients presenting with cardiogenic shock (CS). Experienced TRA operators have started using TRA in CS patients, although the literature is scant. Several datasets have included CS patients in their study population, while others have systematically excluded CS patients when comparing outcomes with TRA to transfemoral access (TFA). In this review, we have compiled the existing literature describing outcomes of patients presenting with CS who underwent PCI using TRA versus TFA. Each dataset has been described in detail and its study population, methodology and conclusions have been critically examined after obtaining all published and most non-published details pertaining to CS patients in these datasets. The contemporary literature consists of observational data comparing access-site related outcomes in CS patients undergoing PCI. Although the composite outcome appears to favor TRA over TFA, the high likelihood of selection bias, with the sickest CS patients getting triaged to TFA, makes an aggressive interpretation of the existing results rather difficult. Despite the operating biases, a few high-quality adjusted analyses clearly report better outcomes in CS patients undergoing PCI via TRA, highlighting an immediate necessity to perform an appropriately powered randomized evaluation of this important question.