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2. Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management

Author

Giuseppe Andò, Bernardo Cortese, Filippo Russo, Martina Rothenbühler, Enrico Frigoli, Giuseppe Gargiulo, Carlo Briguori, Pascal Vranckx, Sergio Leonardi, Vincenzo Guiducci, Flavia Belloni, Fabio Ferrari, Jose Maria de la Torre Hernandez, Salvatore Curello, Francesco Liistro, Andrea Perkan, Stefano De Servi, Gavino Casu, Antonio Dellavalle, Dionigi Fischetti, Antonio Micari, Bruno Loi, Fabio Mangiacapra, Nunzio Russo, Fabio Tarantino, Francesco Saia, Dik Heg, Stephan Windecker, Peter Jüni, Marco Valgimigli, Maria Salomone, Pierpaolo Occhilupo, Veronica Lodolini, Monia Monti, Maria Grazia Mazzone, Erika Delos, Maria Teresa Caruso, Maggie Testa, Nestor Ciociano, Maurizio Lazzero, Davide Gazzotti, Lorenzo Cagliari, Leila Shahmohammadi, Martina Caiazza, Vittorio Virga, Elena Guerra, Eva Michalska, Sara Castellini, Vincenzo Serino, Gabriella Visconti, Gianluca Pendenza, Monica Portolan, Marco Anzini, Elisa Silvetti, Tiziana Coco, Francesco Costa, Sara Ariotti, Linda Valli, Marianna Adamo, Marcello Marino, Pierluigi Tricoci, Andrea Gagnor, Paolo Calabrò, Paolo Rubartelli, Stefano Garducci, Andrea Santarelli, Mario Galli, Roberto Garbo, Ezio Bramucci, Salvatore Ierna, Ugo Limbruno, Roberto Violini, Patrizia Presbitero, Nicoletta de Cesare, Paolo Sganzerla, Arturo Ausiello, Paolo Tosi, Gennaro Sardella, Manel Sabate’, Salvatore Brugaletta, Giovanni Saccone, Pietro Vandoni, Antonio Zingarelli, Armando Liso, Stefano Rigattieri, Emilio Di Lorenzo, Carlo Vigna, Cataldo Palmieri, Camillo Falcone, Raffaele De Caterina, Marcello Caputo, Giovanni Esposito, Alessandro Lupi, Pietro Mazzarotto, Fernando Varbella, Tiziana Zaro, Marco Nazzaro, Sunil V. Rao, Arnoud W.J. van‘t Hof, Elmir Omerovic, Gianluca Campo, Lucia Uguccioni, Corrado Tamburino, Dennis Zavalloni-Parenti, Roberto Ceravolo, Giampaolo Pasquetto, Stefano Mameli, Maria Letizia Stochino, Alberto Cremonesi, Fabio abate, Andrea Picchi, Salvatore Colangelo, Giacomo Boccuzzi, Ferdinando Varbella, Stefano Tresoldi, Marco Contarini, Rosario Evola, Manuela Creaco, Antonio Colombo, Alaide Chieffo, Alessandro Sciahbasi, Edoardo Pucci, Enrico Romagnoli, Claudio Moretti, Luciano Moretti, Marco Zimmarino, Maurizio Ferrario, Maurizio Turturo, Roberto Bonmassari, Carlo Penzo, Ciro Mauro, Anna Sonia Petronio, Gabriele Gabrielli, Francesco Amico, Marco Comeglio, Claudio Fresco, Nicolas Van Mieghem, Roberto Diletti, Evelyn Regar, Manel Sabaté, Joan Antoni Gómez Hospital, José Francisco Díaz Fernández, and Vicente Mainar

Subjects
medicine.medical_specialty, Acute coronary syndrome, estimated glomerular filtration rate, medicine.medical_treatment, Renal function, ST-segment elevation, 030204 cardiovascular system & hematology, Gastroenterology, 03 medical and health sciences, chemistry.chemical_compound, bleeding, coronary intervention, creatinine, 0302 clinical medicine, Internal medicine, medicine, 030212 general & internal medicine, Dialysis, Creatinine, business.industry, Acute kidney injury, Odds ratio, medicine.disease, Confidence interval, Surgery, chemistry, Cardiology and Cardiovascular Medicine, business, Kidney disease
Abstract

Background It remains unclear whether radial access (RA), compared with femoral access (FA), mitigates the risk of acute kidney injury (AKI). Objectives The authors assessed the incidence of AKI in patients with acute coronary syndrome (ACS) enrolled in the MATRIX-Access (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial. Methods Among 8,404 patients, 194 (2.3%) were excluded due to missing creatinine values, no or an incomplete coronary angiogram, or previous dialysis. The primary AKI-MATRIX endpoint was AKI, defined as an absolute (>0.5 mg/dl) or a relative (>25%) increase in serum creatinine (sCr). Results AKI occurred in 634 patients (15.4%) with RA and 712 patients (17.4%) with FA (odds ratio [OR]: 0.87; 95% confidence interval [CI]: 0.77 to 0.98; p = 0.0181). A >25% sCr increase was noted in 633 patients (15.4%) with RA and 710 patients (17.3%) with FA (OR: 0.87; 95% CI: 0.77 to 0.98; p = 0.0195), whereas a >0.5 mg/dl absolute sCr increase occurred in 175 patients (4.3%) with RA versus 223 patients (5.4%) with FA (OR: 0.77; 95% CI: 0.63 to 0.95; p = 0.0131). By implementing the Kidney Disease Improving Global Outcomes criteria, AKI was 3-fold less prevalent and trended lower with RA (OR: 0.85; 95% CI: 0.70 to 1.03; p = 0.090), with stage 3 AKI occurring in 28 patients (0.68%) with RA versus 46 patients (1.12%) with FA (p = 0.0367). Post-intervention dialysis was needed in 6 patients (0.15%) with RA and 14 patients (0.34%) with FA (p = 0.0814). Stratified analyses suggested greater benefit with RA than FA in patients at greater risk for AKI. Conclusions In ACS patients who underwent invasive management, RA was associated with a reduced risk of AKI compared with FA. (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX [MATRIX]; NCT01433627 )

Published
2017

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