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J Am Coll Cardiol. 2017 May 11. pii: S0735-1097(17)36897-3. doi: 10.1016/j.jacc.2017.02.070. [Epub ahead of print]

Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX.

Author information

1
Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino," University of Messina, Messina, Italy.
2
Department of Medicine, Ospedale Fate bene Fratelli, Milano, Italy.
3
Azienda Ospedaliera Sant'Anna, Como, Italy.
4
CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
5
EUSTRATEGY Association, Forli (FC), Italy.
6
Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy; Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.
7
Clinica Mediterranea, Napoli, Italy.
8
Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium.
9
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
10
A.O. Santa Maria Nuova, Reggio Emilia, Italy.
11
Ospedale Santo Spirito in Saxia, Roma, Italy.
12
A.O. Universitaria San Luigi Gonzaga di Orbassano Turin, Italy.
13
Hospital Marques de Valdecilla, Santander, Spain.
14
A.O. Spedali Civili, Brescia, Italy.
15
Ospedale San Donato, Arezzo, Italy.
16
A.S.U.I, Trieste, Italy.
17
Ospedale Civile di Legnano, Legnano, Italy.
18
Ospedale San Francesco, Nuoro, Italy.
19
Ospedali Riuniti ASL 17, Savigliano (CN), Italy.
20
Ospedale Vito Fazzi, Lecce, Italy.
21
GVM Care and Research Maria Eleonora Hospital, Palermo, Italy.
22
A.O. Brotzu, Cagliari, Italy.
23
Campus Biomedico, Roma, Italy.
24
P.O. San Vincenzo, Taormina (ME), Italy.
25
Ospedale G.B. Morgagni, Forlì, Italy.
26
University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
27
Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.
28
Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland; Institute of Primary Health Care, University of Bern, Bern, Switzerland.
29
Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland. Electronic address: marco.valgimigli@insel.ch.

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).

KEYWORDS:

ST-segment elevation; bleeding; coronary intervention; creatinine; estimated glomerular filtration rate

PMID:
28528767
DOI:
10.1016/j.jacc.2017.02.070
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