Impact of vascular access on acute kidney injury after percutaneous coronary intervention.

Andò, Giuseppe; Costa, Francesco; Trio, Olimpia; Oreto, Giuseppe; Valgimigli, Marco (2016). Impact of vascular access on acute kidney injury after percutaneous coronary intervention. Cardiovascular revascularization medicine, 17(5), pp. 333-338. Elsevier 10.1016/j.carrev.2016.03.004

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OBJECTIVES We performed a systematic review of the literature and a meta-analysis to examine the role of access site in affecting the incidence of acute kidney injury (AKI) after percutaneous coronary intervention (PCI). BACKGROUND The vascular access site may play a central role among procedure-related risk factors for AKI after PCI. Transradial access is associated with reduced vascular complications and major bleeding which, in turn, is an emerging risk factor for post-procedural AKI. METHODS Results of six observational studies, three out of six providing propensity matching adjustment, of patients undergoing PCI from the radial and the femoral access were pooled, including overall 26,185 patients. The endpoint was the incidence of study-defined AKI. A meta-regression analysis was performed to further assess the role of study-level covariates. Random-effects models were privileged. RESULTS There was a significant difference in the incidence of AKI after PCI, favoring radial access (odds ratio [OR] 0.51, 95% CI 0.39-0.67, p<0.0001), and the effect size was larger in studies including only patients presenting with ST-elevation myocardial infarction (STEMI) (OR 0.42, 95% CI 0.24-0.72, p=0.001). The meta-regression showed a significant relationship between the benefit of radial access and the proportion of STEMI patients (p=0.031) in each of the included studies. CONCLUSIONS Transradial intervention is associated with a reduction in the incidence of AKI after PCI, as compared to the femoral access, and this benefit is more evident in STEMI patients. These findings warrant further confirmation in randomized controlled trials.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1553-8389

Publisher:

Elsevier

Language:

English

Submitter:

Daria Vogelsang

Date Deposited:

12 Apr 2017 11:25

Last Modified:

12 Apr 2017 11:25

Publisher DOI:

10.1016/j.carrev.2016.03.004

PubMed ID:

27050627

Uncontrolled Keywords:

Acute kidney injury; Percutaneous coronary intervention; ST-elevation myocardial infarction; Transradial intervention

BORIS DOI:

10.7892/boris.92871

URI:

https://boris.unibe.ch/id/eprint/92871

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