Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX

G. Ando, B. Cortese, F. Russo, M. Rothenbuhler, E. Frigoli, G. Gargiulo, C. Briguori, P. Vranckx, Sergio Leonardi, V. Guiducci, F. Belloni, F. Ferrari, J. M. de la Torre Hernandez, S. Curello, F. Liistro, A. Perkan, S. De Servi, G. Casu, A. Dellavalle, D. FischettiA. Micari, B. Loi, F. Mangiacapra, N. Russo, F. Tarantino, F. Saia, D. Heg, S. Windecker, P. Juni, M. Valgimigli, MATRIX Investigators

Research output: Contribution to journalArticle

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).
Original languageEnglish
JournalJournal of the American College of Cardiology
DOIs
Publication statusPublished - May 11 2017

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Acute Coronary Syndrome
Thigh
Acute Kidney Injury
Creatinine
Odds Ratio
Confidence Intervals
Dialysis
Serum
Kidney Diseases
Angiography

Keywords

  • ST-segment elevation
  • bleeding
  • coronary intervention
  • creatinine
  • estimated glomerular filtration rate

Cite this

Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX. / Ando, G.; Cortese, B.; Russo, F.; Rothenbuhler, M.; Frigoli, E.; Gargiulo, G.; Briguori, C.; Vranckx, P.; Leonardi, Sergio; Guiducci, V.; Belloni, F.; Ferrari, F.; Hernandez, J. M. de la Torre; Curello, S.; Liistro, F.; Perkan, A.; Servi, S. De; Casu, G.; Dellavalle, A.; Fischetti, D.; Micari, A.; Loi, B.; Mangiacapra, F.; Russo, N.; Tarantino, F.; Saia, F.; Heg, D.; Windecker, S.; Juni, P.; Valgimigli, M.; Investigators, MATRIX.

In: Journal of the American College of Cardiology, 11.05.2017.

Research output: Contribution to journalArticle

Ando, G, Cortese, B, Russo, F, Rothenbuhler, M, Frigoli, E, Gargiulo, G, Briguori, C, Vranckx, P, Leonardi, S, Guiducci, V, Belloni, F, Ferrari, F, Hernandez, JMDLT, Curello, S, Liistro, F, Perkan, A, Servi, SD, Casu, G, Dellavalle, A, Fischetti, D, Micari, A, Loi, B, Mangiacapra, F, Russo, N, Tarantino, F, Saia, F, Heg, D, Windecker, S, Juni, P, Valgimigli, M & Investigators, MATRIX 2017, 'Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX', Journal of the American College of Cardiology. https://doi.org/S0735-1097(17)36897-3 [pii]
Ando, G. ; Cortese, B. ; Russo, F. ; Rothenbuhler, M. ; Frigoli, E. ; Gargiulo, G. ; Briguori, C. ; Vranckx, P. ; Leonardi, Sergio ; Guiducci, V. ; Belloni, F. ; Ferrari, F. ; Hernandez, J. M. de la Torre ; Curello, S. ; Liistro, F. ; Perkan, A. ; Servi, S. De ; Casu, G. ; Dellavalle, A. ; Fischetti, D. ; Micari, A. ; Loi, B. ; Mangiacapra, F. ; Russo, N. ; Tarantino, F. ; Saia, F. ; Heg, D. ; Windecker, S. ; Juni, P. ; Valgimigli, M. ; Investigators, MATRIX. / Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX. In: Journal of the American College of Cardiology. 2017.
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title = "Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX",
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).",
keywords = "ST-segment elevation, bleeding, coronary intervention, creatinine, estimated glomerular filtration rate",
author = "G. Ando and B. Cortese and F. Russo and M. Rothenbuhler and E. Frigoli and G. Gargiulo and C. Briguori and P. Vranckx and Sergio Leonardi and V. Guiducci and F. Belloni and F. Ferrari and Hernandez, {J. M. de la Torre} and S. Curello and F. Liistro and A. Perkan and Servi, {S. De} and G. Casu and A. Dellavalle and D. Fischetti and A. Micari and B. Loi and F. Mangiacapra and N. Russo and F. Tarantino and F. Saia and D. Heg and S. Windecker and P. Juni and M. Valgimigli and MATRIX Investigators",
note = "LR: 20180121; CI: Copyright (c) 2017; ClinicalTrials.gov/NCT01433627; JID: 8301365; OTO: NOTNLM; 2016/10/28 00:00 [received]; 2017/01/31 00:00 [revised]; 2017/02/02 00:00 [accepted]; 2017/05/23 06:00 [entrez]; 2017/05/23 06:00 [pubmed]; 2017/05/23 06:00 [medline]; aheadofprint",
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journal = "Journal of the American College of Cardiology",
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TY - JOUR

T1 - Acute Kidney Injury After Radial or Femoral Access for Invasive Acute Coronary Syndrome Management: AKI-MATRIX

AU - Ando, G.

AU - Cortese, B.

AU - Russo, F.

AU - Rothenbuhler, M.

AU - Frigoli, E.

AU - Gargiulo, G.

AU - Briguori, C.

AU - Vranckx, P.

AU - Leonardi, Sergio

AU - Guiducci, V.

AU - Belloni, F.

AU - Ferrari, F.

AU - Hernandez, J. M. de la Torre

AU - Curello, S.

AU - Liistro, F.

AU - Perkan, A.

AU - Servi, S. De

AU - Casu, G.

AU - Dellavalle, A.

AU - Fischetti, D.

AU - Micari, A.

AU - Loi, B.

AU - Mangiacapra, F.

AU - Russo, N.

AU - Tarantino, F.

AU - Saia, F.

AU - Heg, D.

AU - Windecker, S.

AU - Juni, P.

AU - Valgimigli, M.

AU - Investigators, MATRIX

N1 - LR: 20180121; CI: Copyright (c) 2017; ClinicalTrials.gov/NCT01433627; JID: 8301365; OTO: NOTNLM; 2016/10/28 00:00 [received]; 2017/01/31 00:00 [revised]; 2017/02/02 00:00 [accepted]; 2017/05/23 06:00 [entrez]; 2017/05/23 06:00 [pubmed]; 2017/05/23 06:00 [medline]; aheadofprint

PY - 2017/5/11

Y1 - 2017/5/11

N2 - 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).

AB - 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).

KW - ST-segment elevation

KW - bleeding

KW - coronary intervention

KW - creatinine

KW - estimated glomerular filtration rate

U2 - S0735-1097(17)36897-3 [pii]

DO - S0735-1097(17)36897-3 [pii]

M3 - Article

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

ER -