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Meta-Analysis
. 2022 Mar 10:2022:6774439.
doi: 10.1155/2022/6774439. eCollection 2022.

Transradial versus Transfemoral Access and the Risk of Acute Kidney Injury following Primary Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Propensity-Score-Matched Studies

Gaspar Del Rio-Pertuz  1 , Michel Juarez  2 , Poemlarp Mekraksakit  1 , Kanak Parmar  1 , Mohammad M Ansari  3
Affiliations
Meta-Analysis

Transradial versus Transfemoral Access and the Risk of Acute Kidney Injury following Primary Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Propensity-Score-Matched Studies

Gaspar Del Rio-Pertuz et al. J Interv Cardiol. .

Abstract

Objectives: The aim of this study is to examine the association between vascular access sites and the incidence of AKI in patients with STEMI undergoing primary PCI.

Background: Emerging evidence has suggested that transradial access (TRA) may be associated with lower rates of acute kidney injury (AKI) as compared with transfemoral access (TFA). However, most of these studies have included a nonselected study population undergoing diagnostic cardiac catheterization or percutaneous coronary intervention (PCI). Data on the association between TRA and AKI in this setting of STEMI are limited and with conflicting results.

Methods: We systematically searched PubMed, Embase, and Scopus for abstracts and full-text articles from inception to July 13th of 2021. Studies included were randomized controlled trials (RCTs) and propensity-score-matched (PSM) studies evaluating the association of TRA versus TFA access with AKI in patients undergoing primary PCI for STEMI. Data were integrated using the random effects model and generic inverse-variance method of DerSimonian and Laird.

Results: A total of 10,093 studies were found. After applying our inclusion criteria, 5 studies from 2014 to 2021 with a total of 8,536 STEMI patients were included. TRA was not significantly associated with a reduced risk for AKI compared with TFA (odds ratio 0.85, 95% CI 0.71-1.01, p 0.07, I 2 = 40%).

Conclusions: Transradial access was not significantly associated with lower risk of AKI in patients undergoing primary PCI for STEMI compared with TFA. Larger studies are needed to clarify this outcome.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart. Selection process for studies to be included in the meta-analysis based on PRISMA standards.
Figure 2
Figure 2
Forest plot. Forest plot demonstrating the no association of transradial access with lower risk of contrast induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction compared with transfemoral access.
Figure 3
Figure 3
Funnel plot. Visual estimation of the funnel plot suggesting a minimal asymmetry, which was quantified to be statistically nonsignificant by means of Egger's regression test (p=0.409). Circles represent observed published studies.
Figure 4
Figure 4
Forest plot. Forest plot using random effects model that demonstrates that transradial access is nonassociated with a significantly lower risk of contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction compared with transfemoral access even after dividing the studies by research type (group 1: randomized controlled trials, group 2: studies where propensity score matching was used).
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