Association of radial versus femoral access with contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

Abstract

BACKGROUND:

Patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are at an increased risk of developing contrast-induced acute kidney injury (CI-AKI). Data on the association between transradial (TRA) vs. transfemoral (TFA) access and the risk of CI-AKI in this setting are limited.

METHODS:

We analyzed data on 1162 patients undergoing primary PCI for STEMI at two tertiary care centers between 2010 and 2014. Primary outcome was CI-AKI, defined as a relative rise in serum creatinine of ≥25%, or an absolute increase of ≥0.5 mg/dL, within 48 h of primary PCI. We used multivariable logistic regression and propensity analysis to determine the association between vascular access site and CI-AKI.

RESULTS:

Of 1162 patients who underwent primary PCI for STEMI, TFA was used in 857 (73.8%), and TRA in 305 (26.2%) patients. In the unmatched cohort, TRA was associated with numerically lower rates of CI-AKI as compared with TFA; however, this difference did not reach statistical significance (5.9% vs. 7.0%; unadjusted OR 0.83, 95%CI 0.48–1.44, p = 0.510; adjusted OR 0.84, 95%CI 0.44–1.62, p = 0.610). Similar results were seen in a propensity matched cohort of 508 patients (254 TRA and 254 TFA; CI-AKI 5.5% vs. 8.3%, OR 0.65, 95% CI 0.32–1.30, p = 0.220).

CONCLUSIONS:

In patients with STEMI undergoing primary PCI, TRA was not associated with a lower risk of CI-AKI, as compared with TFA. Randomized controlled trials are needed to definitely assess the role of vascular access site in reducing the risk of CI-AKI in patients undergoing primary PCI for STEMI.

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Citation
Cardiovasc Revasc Med. 2016 Dec;17(8):546-551.