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. 2024 Apr 18;13(8):2367.
doi: 10.3390/jcm13082367.

Acute Kidney Injury in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: The Role of Vascular Access Site

Stefano Rigattieri  1 , Ernesto Cristiano  1   2 , Federica Tempestini  1 , Luca Pittorino  1 , Vincenzo Cesario  1 , Matteo Casenghi  1 , Francesca Giovannelli  1 , Antonella Tommasino  1 , Emanuele Barbato  1   3 , Andrea Berni  1   3
Affiliations

Acute Kidney Injury in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: The Role of Vascular Access Site

Stefano Rigattieri et al. J Clin Med. .

Abstract

Background: in patients undergoing percutaneous coronary interventions (PCI), radial access should be favoured over femoral access as it reduces the risk of vascular complications and bleeding. Furthermore, a preventive role of radial access in the occurrence of acute kidney injury (AKI), mainly mediated by the reduction of bleeding and cholesterol crystal embolization into renal circulation, has been investigated in several studies, yielding conflicting results. Methods: we designed a retrospective study to appraise the effect of the use of a vascular access site on the occurrence of AKI in a cohort of 633 patients with acute myocardial infarction treated by PCI at our centre from 2018 to 2020. Results: after propensity score adjustment, radial access was associated with a reduced, albeit statistically not significant, incidence of AKI (14.7% vs. 21.0%; p = 0.06) and major bleeding (12.5% vs. 18.7%; p = 0.04) as compared to femoral access. At multivariate analysis, femoral access was an independent predictor of AKI, together with in-hospital occurrence of BARC 3-5 bleeding, Killip class >1 at presentation, female gender, baseline eGFR <60 mL/min, and baseline haemoglobin <12 g/dL. Conclusions: although limited by the observational design, our study supports the hypothesis that radial access may exert a protective role on the occurrence of AKI in patients with acute myocardial infarction undergoing PCI.

Keywords: NSTEMI; STEMI; multivessel disease.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study design. AMI: acute myocardial infarction; PCI: percutaneous coronary intervention; PS: propensity score; NNM: nearest neighbour matching; IPTW: inverse probability of treatment weighting. In the bottom right panel, the “pseudopopulation”, obtained by weighting each individual by the inverse probability of receiving his/her actual treatment, is shown.
Figure 2
Figure 2
(A) Rebalance of variable expressed as standardized mean differences (SMD); SMD lower than 0.1 was considered as good rebalancing. For every variable, there are two box plots; the first for original data, and the second for after MICE estimation for missing data. The variables are: a. age, b. arterial hypertension, c. BMI, d. basal creatinine, e. dyslipidaemia, f. diabetes mellitus, g. familiarity for CAD, h. smoke, i. basal Hb, j. Killip class, k. NYHA class, l. PAD, m. previous cardiovascular event, n. previous HF, o. sex, and p. STEMI. (B) Common support of propensity score between radial and femoral access; the graph shows the good overlap between the two groups.
Figure 3
Figure 3
Rate of acute kidney injury and major bleeding in the propensity-matched cohort according to vascular access.
Figure 4
Figure 4
Propensity score weighting: multivariable logistic regression.
Figure 5
Figure 5
Propensity score matching: multivariable logistic regression.
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