STEMI with shock — EECC MCQ

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EasyCoronary Artery RevascularizationSTEMI with shockEECC

A 72-year-old with STEMI and shock undergoes PCI. Post-PCI, which access-site strategy aligns with guideline preference to reduce bleeding?

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Correct answer: E — Radial access preferred where expertise exists

The correct access-site strategy is radial arterial access where local operator expertise and anatomy make it feasible. In UK practice, NICE recommends radial access in preference to femoral for coronary angiography with follow-on primary PCI if indicated. This applies in acute STEMI, including patients requiring urgent angiography/PCI for cardiogenic shock; shock is not a reason to prefer femoral access routinely. The rationale is that radial access reduces access-site bleeding and vascular complications compared with femoral access. Femoral access may still be used when radial access is not feasible or when specific technical requirements demand it, but it is not the guideline-preferred default. Brachial and carotid access are not preferred PCI access strategies.

Reference: NICE guideline NG185, Acute coronary syndromes, published 2020 and last reviewed 27 March 2026; recommendations 1.1.7 and 1.1.10. https://www.nice.org.uk/guidance/ng185/chapter/recommendations