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.
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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Introduction
Contrast-induced acute kidney injury (CI-AKI) is an important complication of percutaneous coronary intervention (PCI) and is associated with increased morbidity and mortality . The reported incidence of AKI after PCI varies widely, from 2% to 25%, depending on the patient population studied and the definition of AKI used . Baseline renal function and contrast volume are important predictors of CI-AKI . However, other patient- and procedure-related risk factors have also been recognized . Recently, emerging evidence from observational studies and meta-analysis suggest that transradial access (TRA) may be associated with lower rates of CI-AKI as compared with transfemoral access (TFA) . However, the results have been inconsistent, and most of these studies have included a non-selected study population of patients undergoing diagnostic cardiac catheterization or PCI. Patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI represent a high-risk cohort. Importantly, patients with STEMI have a 2.6-fold higher risk of developing AKI as compared with non-acute coronary syndrome patients undergoing PCI . TRA is used less frequently in patients with STEMI and data on association between TRA and CI-AKI in this setting are limited with conflicting results . The primary objective of this study, therefore, was to examine the association between vascular access site (TRA vs. TFA) and the incidence of CI-AKI in a contemporary cohort of patients with STEMI undergoing primary PCI.
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