Association of acute kidney injury and bleeding events with mortality after radial or femoral access in patients with acute coronary syndrome undergoing invasive management: secondary analysis of a randomized clinical trial.

Rothenbühler, Martina; Valgimigli, Marco; Odutayo, Ayodele; Frigoli, Enrico; Leonardi, Sergio; Vranckx, Pascal; Turturo, Maurizio; Moretti, Luciano; Amico, Francesco; Uguccioni, Lucia; Contarini, Marco; Gómez-Hospital, Joan Antoni; Mainar, Vicente; Creaco, Manuela; Petronio, Anna Sonia; Cremonesi, Alberto; Tamburino, Corrado; Fresco, Claudio; Bonmassari, Roberto; Díaz Fernández, José Francisco; ... (2019). Association of acute kidney injury and bleeding events with mortality after radial or femoral access in patients with acute coronary syndrome undergoing invasive management: secondary analysis of a randomized clinical trial. European Heart Journal, 40(15), pp. 1226-1232. Oxford University Press 10.1093/eurheartj/ehy860

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Aims In the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) trial, adults with acute coronary syndrome undergoing coronary intervention who were allocated to radial access had a lower risk of bleeding, acute kidney injury (AKI), and all-cause mortality, as compared with those allocated to femoral access. The mechanism of the mortality benefit of radial access remained unclear. Methods and results We used multistate and competing risk models to determine the effects of radial and femoral access on bleeding, AKI and all-cause mortality in the MATRIX trial and to disentangle the relationship between these different types of events. There were large relative risk reductions in mortality for radial compared with femoral access for the transition from AKI to death [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.31-0.97] and for the pathway from coronary intervention to AKI to death (HR 0.49, 95% CI 0.26-0.92). Conversely, there was little evidence for a difference between radial and femoral groups for the transition from bleeding to death (HR 1.05, 95% CI 0.42-2.64) and the pathway from coronary intervention to bleeding to death (HR 0.84, 95% CI 0.28-2.49). Conclusion The prevention of AKI appeared predominantly responsible for the mortality benefit of radial as compared with femoral access in the MATRIX trial. There was little evidence for an equally important, independent role of bleeding.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Rothenbühler, Martina; Valgimigli, Marco; Frigoli, Enrico and Heg, Dierik Hans

Subjects:

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

ISSN:

0195-668X

Publisher:

Oxford University Press

Language:

English

Submitter:

Beatrice Minder Wyssmann

Date Deposited:

28 Feb 2019 16:18

Last Modified:

16 Apr 2019 01:32

Publisher DOI:

10.1093/eurheartj/ehy860

PubMed ID:

30689825

BORIS DOI:

10.7892/boris.126081

URI:

https://boris.unibe.ch/id/eprint/126081

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