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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/26465

Title: Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management AKI-MATRIX
Authors: Ando, Giuseppe
Cortese, Bernardo
Russo, Filippo
Rothenbhler, Martina
Frigoli, Enrico
Gargiulo, Giuseppe
Briguori, Carlo
Vranckx, Pascal
Leonardi, Sergio
Guiducci, Vincenzo
Belloni, Flavia
Ferrari, Fabio
Hernandez, Jose Maria de la Torre
Curello, Salvatore
Liistro, Francesco
Perkan, Andrea
De Servi, Stefano
Casu, Gavino
Dellavalle, Antonio
Fischetti, Dionigi
Micari, Antonio
Loi, Bruno
Mangiacapra, Fabio
Russo, Nunzio
Tarantino, Fabio
Saia, Francesco
Heg, Dik
Windecker, Stephan
Juni, Peter
Valgimigli, Marco
Issue Date: 2017
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) (J Am Coll Cardiol 2017; 69: 2592-603) (C) 2017 by the American College of Cardiology Foundation.
URI: http://hdl.handle.net/1942/26465
DOI: 10.1016/j.jacc.2017.02.070
ISI #: 000401695900003
ISSN: 0735-1097
Category: A1
Type: Journal Contribution
Appears in Collections: Research publications

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