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Association of radial versus femoral access with contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.
Cardiovasc Revasc Med. 2016 Dec; 17(8):546-551.CR

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 ≥0.5mg/dL, within 48h 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.

SUMMARY

In patients with STEMI undergoing primary PCI, the overall incidence of contrast-induced acute kidney injury (CI-AKI) was low (6.7%). Transradial access was not associated with a lower risk of CI-AKI as compared with transfemoral access.

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    Authors+Show Affiliations

    Kolte D
    Division of Cardiology, Brown University, Providence, RI.
    Spence N
    Department of Medicine, Brown University, Providence, RI.
    Puthawala M
    Department of Medicine, Brown University, Providence, RI.
    Hyder O
    Division of Cardiology, Brown University, Providence, RI.
    Tuohy CP
    Department of Medicine, Brown University, Providence, RI.
    Davidson CB
    Department of Medicine, Brown University, Providence, RI.
    Sheldon MW
    Division of Cardiology, University of New Mexico, Albuquerque, NM.
    Laskey WK
    Division of Cardiology, University of New Mexico, Albuquerque, NM.
    Abbott JD
    Division of Cardiology, Brown University, Providence, RI. Electronic address: JAbbott@Lifespan.org.

    MeSH

    Acute Kidney InjuryAgedBiomarkersCatheterization, PeripheralChi-Square DistributionContrast MediaCreatinineFemaleFemoral ArteryHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisNew MexicoOdds RatioPercutaneous Coronary InterventionPredictive Value of TestsPropensity ScorePuncturesRadial ArteryRetrospective StudiesRhode IslandRisk AssessmentRisk FactorsST Elevation Myocardial InfarctionTertiary Care CentersTime FactorsTreatment OutcomeUp-Regulation

    Pub Type(s)

    Comparative Study
    Journal Article
    Multicenter Study
    Observational Study

    Language

    eng

    PubMed ID

    27566903

    Citation

    Kolte, Dhaval, et al. "Association of Radial Versus Femoral Access With Contrast-induced Acute Kidney Injury in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction." Cardiovascular Revascularization Medicine : Including Molecular Interventions, vol. 17, no. 8, 2016, pp. 546-551.
    Kolte D, Spence N, Puthawala M, et al. Association of radial versus femoral access with contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Cardiovasc Revasc Med. 2016;17(8):546-551.
    Kolte, D., Spence, N., Puthawala, M., Hyder, O., Tuohy, C. P., Davidson, C. B., Sheldon, M. W., Laskey, W. K., & Abbott, J. D. (2016). Association of radial versus femoral access with contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Cardiovascular Revascularization Medicine : Including Molecular Interventions, 17(8), 546-551. https://doi.org/10.1016/j.carrev.2016.07.008
    Kolte D, et al. Association of Radial Versus Femoral Access With Contrast-induced Acute Kidney Injury in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction. Cardiovasc Revasc Med. 2016;17(8):546-551. PubMed PMID: 27566903.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Association of radial versus femoral access with contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. AU - Kolte,Dhaval, AU - Spence,Nathan, AU - Puthawala,Mohamedtauqir, AU - Hyder,Omar, AU - Tuohy,Christopher P, AU - Davidson,Carolyn B, AU - Sheldon,Mark W, AU - Laskey,Warren K, AU - Abbott,J Dawn, Y1 - 2016/07/21/ PY - 2016/06/29/received PY - 2016/07/18/accepted PY - 2016/8/28/pubmed PY - 2017/2/28/medline PY - 2016/8/28/entrez KW - Acute kidney injury KW - Percutaneous coronary intervention KW - Radial artery KW - ST-elevation myocardial infarction SP - 546 EP - 551 JF - Cardiovascular revascularization medicine : including molecular interventions JO - Cardiovasc Revasc Med VL - 17 IS - 8 N2 - 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 ≥0.5mg/dL, within 48h 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. SUMMARY: In patients with STEMI undergoing primary PCI, the overall incidence of contrast-induced acute kidney injury (CI-AKI) was low (6.7%). Transradial access was not associated with a lower risk of CI-AKI as compared with transfemoral access. SN - 1878-0938 UR - https://www.unboundmedicine.com/medline/citation/27566903/Association_of_radial_versus_femoral_access_with_contrast_induced_acute_kidney_injury_in_patients_undergoing_primary_percutaneous_coronary_intervention_for_ST_elevation_myocardial_infarction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-8389(16)30195-6 DB - PRIME DP - Unbound Medicine ER -

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