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

2017; Elsevier BV; Volume: 69; Issue: 21 Linguagem: Inglês

10.1016/j.jacc.2017.02.070

1558-3597

Giuseppe Andò, Bernardo Cortese, Filippo Russo, Martina Rothenbühler, Enrico Frigoli, Giuseppe Gargiulo, Carlo Briguori, Pascal Vranckx, Sergio Leonardi, Vincenzo Guiducci, Flavia Belloni, Fabio Ferrari, José M. de la Torre Hernández, Salvatore Curello, Francesco Liïstro, 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, Enrico Frigoli, 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, E Michalska, S 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, Pascal Vranckx, Sergio Leonardi, Pierluigi Tricoci, Peter Jüni, Martina Rothenbühler, Dik Heg, Marco Valgimigli, Andrea Gagnor, Paolo Calabró, Paolo Rubartelli, Stefano Garducci, Giuseppe Andò, Andrea Santarelli, Mario Galli, Roberto Garbo, Ezio Bramucci, Salvatore Ierna, Carlo Briguori, Bernardo Cortese, Ugo Limbruno, Roberto Violini, Patrizia Presbitero, Nicoletta De Cesare, Paolo Sganzerla, Arturo Ausiello, Paolo Tosi, Gennaro Sardella, Manel Sabaté, Salvatore Brugaletta, Giovanni Saccone, Pietro Vandoni, Antonio Zingarelli, Armando Liso, Stefano Rigattieri, Emilio Di Lorenzo, Carlo Vigna, Cataldo Palmieri, Camillo Falcone, Raffaele De Caterina, Massimo Caputo, Giovanni Esposito, Alessandro Lupi, Pietro Mazzarotto, F Varbella, Tiziana Zaro, Marco Stefano Nazzaro, Sunil V. Rao, Arnoud W.J. van ‘t Hof, Elmir Ömerovic, Paolo Calabró, Arnoud W.J. van ‘t Hof, Manel Sabaté, Salvatore Brugaletta, Elmir Ömerovic, Gianluca Campo, Marco Valgimigli, Lucia Uguccioni, Corrado Tamburino, Patrizia Presbitero, Dennis Zavalloni-Parenti, Fabio Ferrari, Roberto Ceravolo, Andrea Santarelli, Fabio Tarantino, Paolo Calabró, Giampaolo Pasquetto, Giovanni Esposito, Salvatore Ierna, Gavino Casu, Stefano Mameli, Maria Letizia Stochino, Nicoletta De Cesare, Pietro Mazzarotto, Alberto Cremonesi, Francesco Saia, Giovanni Saccone, Fabio Abate, Ugo Limbruno, Andrea Picchi, Roberto Violini, Marco Stefano Nazzaro, Roberto Garbo, Salvatore Colangelo, Giacomo Boccuzzi, Paolo Tosi, Vincenzo Guiducci, Carlo Vigna, Antonio Zingarelli, Andrea Gagnor, Ferdinando Varbella, Stefano Garducci, Tiziana Zaro, Stefano Tresoldi, Pietro Vandoni, Marco Contarini, Armando Liso, Antonio Dellavalle, Salvatore Curello, Fabio Mangiacapra, Paolo Rubartelli, Rosario Evola, Giuseppe Andò, Cataldo Palmieri, Camillo Falcone, Francesco Liïstro, Manuela Creaco, Antonio Colombo, Alaide Chieffo, Andrea Perkan, Stefano De Servi, Dionigi Fischetti, Stefano Rigattieri, Alessandro Sciahbasi, Edoardo Pucci, Enrico Romagnoli, Claudio Moretti, Luciano Moretti, Raffaele De Caterina, Massimo Caputo, Marco Zimmarino, Paolo Sganzerla, Maurizio Ferrario, Ezio Bramucci, Emilio Di Lorenzo, Carlo Briguori, Maurizio Turturo, Roberto Bonmassari, Carlo Penzo, Bruno Loi, Ciro Mauro, Arturo Ausiello, Anna Sonia Petronio, Gabriele Gabrielli, Gennaro Sardella, Antonio Micari, Flavia Belloni, Alessandro Lupi, Francesco Amico, Marco Comeglio, Claudio Fresco, Arnoud W.J. van ‘t Hof, Nicolas M. Van Mieghem, Roberto Diletti, Evelyn Regar, Elmir Ömerovic, Salvatore Brugaletta, Manel Sabaté, Joan Antoni Gómez Hospital, José Francisco Díaz Fernández, Vicente Mainar, José M. de la Torre Hernández,

Acute Kidney Injury Research

It remains unclear whether radial access (RA), compared with femoral access (FA), mitigates the risk of acute kidney injury (AKI). 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. 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). 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. 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)