Impact of vascular access on acute kidney injury after percutaneous coronary intervention.
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BORIS DOI
Publisher DOI
PubMed ID
27050627
Description
OBJECTIVES
We performed a systematic review of the literature and a meta-analysis to examine the role of access site in affecting the incidence of acute kidney injury (AKI) after percutaneous coronary intervention (PCI).
BACKGROUND
The vascular access site may play a central role among procedure-related risk factors for AKI after PCI. Transradial access is associated with reduced vascular complications and major bleeding which, in turn, is an emerging risk factor for post-procedural AKI.
METHODS
Results of six observational studies, three out of six providing propensity matching adjustment, of patients undergoing PCI from the radial and the femoral access were pooled, including overall 26,185 patients. The endpoint was the incidence of study-defined AKI. A meta-regression analysis was performed to further assess the role of study-level covariates. Random-effects models were privileged.
RESULTS
There was a significant difference in the incidence of AKI after PCI, favoring radial access (odds ratio [OR] 0.51, 95% CI 0.39-0.67, p<0.0001), and the effect size was larger in studies including only patients presenting with ST-elevation myocardial infarction (STEMI) (OR 0.42, 95% CI 0.24-0.72, p=0.001). The meta-regression showed a significant relationship between the benefit of radial access and the proportion of STEMI patients (p=0.031) in each of the included studies.
CONCLUSIONS
Transradial intervention is associated with a reduction in the incidence of AKI after PCI, as compared to the femoral access, and this benefit is more evident in STEMI patients. These findings warrant further confirmation in randomized controlled trials.
We performed a systematic review of the literature and a meta-analysis to examine the role of access site in affecting the incidence of acute kidney injury (AKI) after percutaneous coronary intervention (PCI).
BACKGROUND
The vascular access site may play a central role among procedure-related risk factors for AKI after PCI. Transradial access is associated with reduced vascular complications and major bleeding which, in turn, is an emerging risk factor for post-procedural AKI.
METHODS
Results of six observational studies, three out of six providing propensity matching adjustment, of patients undergoing PCI from the radial and the femoral access were pooled, including overall 26,185 patients. The endpoint was the incidence of study-defined AKI. A meta-regression analysis was performed to further assess the role of study-level covariates. Random-effects models were privileged.
RESULTS
There was a significant difference in the incidence of AKI after PCI, favoring radial access (odds ratio [OR] 0.51, 95% CI 0.39-0.67, p<0.0001), and the effect size was larger in studies including only patients presenting with ST-elevation myocardial infarction (STEMI) (OR 0.42, 95% CI 0.24-0.72, p=0.001). The meta-regression showed a significant relationship between the benefit of radial access and the proportion of STEMI patients (p=0.031) in each of the included studies.
CONCLUSIONS
Transradial intervention is associated with a reduction in the incidence of AKI after PCI, as compared to the femoral access, and this benefit is more evident in STEMI patients. These findings warrant further confirmation in randomized controlled trials.
Date of Publication
2016-07
Publication Type
Article
Subject(s)
Keyword(s)
Acute kidney injury
•
Percutaneous coronary intervention
•
ST-elevation myocardial infarction
•
Transradial intervention
Language(s)
en
Contributor(s)
Andò, Giuseppe | |
Costa, Francesco | |
Trio, Olimpia | |
Oreto, Giuseppe |
Additional Credits
Series
Cardiovascular revascularization medicine
Publisher
Elsevier
ISSN
1553-8389
Access(Rights)
restricted