Acute kidney injury in patients with myocardial infarction undergoing percutaneous coronary intervention using radial versus femoral access

Abstract

BackgroundData on radial access (RA) as an independent risk factor for acute kidney injury (AKI) in myocardial infarction (MI) patients are conflicting. Our aim was to assess how RA influences the incidence of AKI in MI patients undergoing percutaneous coronary intervention (PCI).MethodsData from 3842 MI patients undergoing PCI at our institution from January 2011 to December 2016, of which 35.8% were performed radially, were retrospectively analyzed. A propensity-matched analysis was performed to adjust for differences in the baseline characteristics between the RA and femoral access (FA) groups. The effect of RA on the incidence of AKI was observed.ResultsIn the unmatched cohort, AKI occurred less often in the RA group [77 (5.6%) patients in the RA group compared to 250 (10.1%) patients in the FA group; p = 0.001]. After propensity-matched adjustment, the incidence of AKI was similar in the two groups.After adjustment for potential confounders, RA was not identified as an independent predictive factor for AKI in either the unmatched or the propensity-matched cohort. Bleeding, heart failure, age ≥ 70 years, renal dysfunction, and the contrast volume/GFR ratio predicted AKI in both cohorts. Additionally, diabetes, contrast volume, and hypertension were predictive of AKI in the unmatched cohort.ConclusionThe access site was not independently associated with the incidence of AKI in patients with MI in both a non-matched and a propensity-matched cohort. Our study result suggests that the lower incidence of AKI in patients treated with RA in an unmatched cohort might be substantially influenced by confounding factors, especially bleeding.Electronic supplementary materialThe online version of this article (10.1186/s12882-019-1210-8) contains supplementary material, which is available to authorized users.

Comparison of acute kidney injury with radial vs. femoral access for patients undergoing coronary catheterization: An updated meta‑analysis of 46,816 patients

“…A total of 5 studies were then excluded, as 2 reported data (16,17) from an already included RCT and the other 3 studies (18-20) did not report on the incidence of AKI. A total of 14 studies were included in this systematic review and meta-analysis (8)(9)(10)(11)(12)(21)(22)(23)(24)(25)(26)(27)(28)(29).…”

“…Two studies ( 8 , 10 ) were RCTs, while the remaining studies were retrospective in nature. Furthermore, six retrospective studies utilized propensity score matching to harmonize the baseline characteristics of the study participants ( 9 , 12 , 22 , 25 , 27 , 29 ). In the included studies, participants underwent coronary catheterization for a variety of reasons.…”

“…It is important to note that the current meta-analysis pooled a heterogeneous group of studies involving 2 RCTs, 6 retrospective studies without matching the baseline study population and 6 studies utilizing propensity-scored matched data. Individually, 7 studies (8,9,11,12,24,28,29) did not report any association between the vascular access site and AKI, while the remaining studies demonstrated a significantly reduced incidence of AKI with the radial route (10,(21)(22)(23)(25)(26)(27). Among the studies not reporting any difference between the radial and the femoral route were 1 RCT, 3 retrospective studies and 3 propensity-scored matched studies.…”

“…As compared to the previous meta-analysis (7), the present study was able to incorporate 4 further studies (8,11,12,24); it included the data of a total of 46,816 patients and is therefore a significant update. In addition to the subgroup analysis based on study type, the influence of the definition of AKI on the pooled effect size was also analyzed.…”

“…Despite several retrospective studies utilizing multivariate regression analysis to adjust for baseline characteristics for reporting outcomes, no attempt has been made to date to collate such data and analyze the overall evidence on the incidence of AKI with radial vs. femoral access, to the best of our knowledge. In addition, with further studies published (8,11,12), there is a requirement for an updated review and meta-analysis on this important topic. Therefore, the purpose of the present study was to perform a comprehensive updated review and meta-analysis comparing AKI following the radial vs. femoral route of coronary catheterization.…”