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Acute Kidney Injury in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: The

Stefano Rigattieri1, Ernesto Cristiano1,2, Federica Tempestini1

  • 1Cardiology Division, Sant'Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.

Journal of Clinical Medicine
|April 27, 2024
PubMed

Insights

Radial access may reduce acute kidney injury (AKI) risk in patients undergoing percutaneous coronary interventions (PCI). Femoral access was an independent predictor of AKI, suggesting radial access offers a protective benefit.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Radial access is preferred over femoral access during percutaneous coronary interventions (PCI) due to lower vascular complication and bleeding risks.
  • The potential protective effect of radial access against acute kidney injury (AKI) in PCI patients is debated, with conflicting study results.
  • AKI in PCI patients may be linked to bleeding and cholesterol crystal embolization, potentially influenced by vascular access site choice.

Purpose of the Study:

  • To evaluate the impact of vascular access site (radial vs. femoral) on AKI occurrence in acute myocardial infarction (AMI) patients undergoing PCI.
  • To investigate the association between radial access and reduced incidence of AKI and major bleeding.
  • To identify independent predictors of AKI in patients with AMI treated with PCI.

Main Methods:

  • Retrospective cohort study of 633 patients with AMI treated by PCI between 2018 and 2020.
  • Propensity score adjustment was used to compare AKI and major bleeding rates between radial and femoral access groups.
  • Multivariate analysis was performed to identify independent predictors of AKI.

Main Results:

  • After propensity score adjustment, radial access showed a non-significant trend towards reduced AKI (14.7% vs. 21.0%, p=0.06) and significantly reduced major bleeding (12.5% vs. 18.7%, p=0.04) compared to femoral access.
  • Femoral access was identified as an independent predictor of AKI.
  • Other independent predictors of AKI included in-hospital BARC 3-5 bleeding, Killip class >1, female gender, low baseline eGFR, and low baseline hemoglobin.

Conclusions:

  • This observational study supports the hypothesis that radial access may offer a protective role against AKI in patients with AMI undergoing PCI.
  • While not statistically significant in this cohort, the trend suggests a potential benefit of radial access in preventing AKI.
  • Further prospective studies are warranted to confirm the protective effect of radial access on AKI in PCI patients.

Keywords:
NSTEMISTEMImultivessel disease

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