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Title: | Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management AKI-MATRIX | Authors: | Ando, Giuseppe Cortese, Bernardo Russo, Filippo Rothenbhler, Martina Frigoli, Enrico Gargiulo, Giuseppe Briguori, Carlo VRANCKX, Pascal Leonardi, Sergio Guiducci, Vincenzo Belloni, Flavia Ferrari, Fabio Hernandez, Jose Maria de la Torre Curello, Salvatore Liistro, Francesco Perkan, Andrea De Servi, Stefano Casu, Gavino Dellavalle, Antonio Fischetti, Dionigi Micari, Antonio Loi, Bruno Mangiacapra, Fabio Russo, Nunzio Tarantino, Fabio Saia, Francesco Heg, Dik Windecker, Stephan Juni, Peter Valgimigli, Marco |
Issue Date: | 2017 | Source: | JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 69(21), p. 2592-2603 | Abstract: | 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) (J Am Coll Cardiol 2017; 69: 2592-603) (C) 2017 by the American College of Cardiology Foundation. | Keywords: | bleeding; coronary intervention; creatinine; estimated glomerular filtration rate; ST-segment elevation | Document URI: | http://hdl.handle.net/1942/26465 | ISSN: | 0735-1097 | e-ISSN: | 1558-3597 | DOI: | 10.1016/j.jacc.2017.02.070 | ISI #: | 000401695900003 | Rights: | (C) 2017 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIER | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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