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

Andò, Giuseppe; Cortese, Bernardo; Russo, Filippo; Rothenbühler, Martina; Frigoli, Enrico; Gargiulo, Giuseppe; Briguori, Carlo; Vranckx, Pascal; Leonardi, Sergio; Guiducci, Vincenzo; Belloni, Flavia; Ferrari, Fabio; de la Torre Hernandez, Jose Maria; Curello, Salvatore; Liistro, Francesco; Perkan, Andrea; De Servi, Stefano; Casu, Gavino; Dellavalle, Antonio; Fischetti, Dionigi; ... (2017). Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX. Journal of the American College of Cardiology, 69(21), pp. 2592-603. Elsevier 10.1016/j.jacc.2017.02.070

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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).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Rothenbühler, Martina; Gargiulo, Giuseppe; Heg, Dierik Hans; Windecker, Stephan; Jüni, Peter and Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0735-1097

Publisher:

Elsevier

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

24 Aug 2017 15:43

Last Modified:

12 Sep 2017 19:31

Publisher DOI:

10.1016/j.jacc.2017.02.070

PubMed ID:

28528767

Uncontrolled Keywords:

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

BORIS DOI:

10.7892/boris.102369

URI:

https://boris.unibe.ch/id/eprint/102369

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