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. 2017 May 11:S0735-1097(17)36897-3.
doi: 10.1016/j.jacc.2017.02.070. Online ahead of print.

Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX

Giuseppe Andò  1 , Bernardo Cortese  2 , Filippo Russo  3 , Martina Rothenbühler  4 , Enrico Frigoli  5 , Giuseppe Gargiulo  6 , Carlo Briguori  7 , Pascal Vranckx  8 , Sergio Leonardi  9 , Vincenzo Guiducci  10 , Flavia Belloni  11 , Fabio Ferrari  12 , Jose Maria de la Torre Hernandez  13 , Salvatore Curello  14 , Francesco Liistro  15 , Andrea Perkan  16 , Stefano De Servi  17 , Gavino Casu  18 , Antonio Dellavalle  19 , Dionigi Fischetti  20 , Antonio Micari  21 , Bruno Loi  22 , Fabio Mangiacapra  23 , Nunzio Russo  24 , Fabio Tarantino  25 , Francesco Saia  26 , Dik Heg  4 , Stephan Windecker  27 , Peter Jüni  28 , Marco Valgimigli  29 ; MATRIX Investigators
Affiliations
Free article

Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX

Giuseppe Andò et al. J Am Coll Cardiol. .
Free article

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).

Keywords: ST-segment elevation; bleeding; coronary intervention; creatinine; estimated glomerular filtration rate.

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