Radial Access and Acute Kidney Injury

May 25, 2017
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Authors:
Andò G, Cortese B, Russo F, et al.
Citation:
Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX. J Am Coll Cardiol 2017;69:2592-2603.
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

Does radial access reduce the risk of acute kidney injury (AKI)?

Methods:

The author assessed the incidence of AKI among patients randomized to radial versus femoral access in the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX) trial. AKI was defined as an absolute (>0.5 mg/dl) or a relative (>25%) increase in serum creatinine (sCr).

Results:

AKI was lower with radial access compared with femoral access (15.4% vs. 17.4%; odds ratio [OR], 0.87; 95% confidence interval [CI], 0.77-0.98; p = 0.018). This was driven by both a reduction in >25% increase in sCr (15.4% vs. 17.3%; OR, 0.87; 95% CI, 0.77-0.98; p = 0.0195) and in >0.5 mg/dl absolute sCr increase (4.3% vs. 5.4%; OR, 0.77; 95% CI, 0.63-0.95; p = 0.0131). Radial access was also associated with a trend toward lower incidence of new need for dialysis (0.15% vs. 0.34%; p = 0.08).

Conclusions:

The authors concluded that radial access is associated with a lower incidence of AKI in patients undergoing invasive management of acute coronary syndromes.

Perspective:

This study adds to the growing data supporting the superiority of the radial first approach. The findings of this study are consistent with those noted from earlier observational studies, appear biologically plausible, and provide another impetus to consider radial access as the preferred approach for patients undergoing coronary angiography and intervention.

Keywords: Acute Coronary Syndrome, Acute Kidney Injury, Coronary Angiography, Creatinine, Femoral Artery, Hemorrhage, Radial Artery, Renal Dialysis, Risk


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