Association of acute kidney injury and bleeding events with mortality after radial or femoral access in patients with acute coronary syndrome undergoing invasive management: secondary analysis of a randomized clinical trial

Martina Rothenbühler, Marco Valgimigli, Ayodele Odutayo, Enrico Frigoli, Sergio Leonardi, Pascal Vranckx, Maurizio Turturo, Luciano Moretti, Francesco Amico, Lucia Uguccioni, Marco Contarini, Joan Antoni Gómez-Hospital, Vicente Mainar, Manuela Creaco, Anna Sonia Petronio, Alberto Cremonesi, Corrado Tamburino, Claudio Fresco, Roberto Bonmassari, José Francisco Díaz FernándezEnrico Romagnoli, Jan Beyersmann, Dik Heg, Peter Jüni

Research output: Contribution to journalArticlepeer-review

Abstract

AIMS: In the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) trial, adults with acute coronary syndrome undergoing coronary intervention who were allocated to radial access had a lower risk of bleeding, acute kidney injury (AKI), and all-cause mortality, as compared with those allocated to femoral access. The mechanism of the mortality benefit of radial access remained unclear. METHODS AND RESULTS: We used multistate and competing risk models to determine the effects of radial and femoral access on bleeding, AKI and all-cause mortality in the MATRIX trial and to disentangle the relationship between these different types of events. There were large relative risk reductions in mortality for radial compared with femoral access for the transition from AKI to death [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.31-0.97] and for the pathway from coronary intervention to AKI to death (HR 0.49, 95% CI 0.26-0.92). Conversely, there was little evidence for a difference between radial and femoral groups for the transition from bleeding to death (HR 1.05, 95% CI 0.42-2.64) and the pathway from coronary intervention to bleeding to death (HR 0.84, 95% CI 0.28-2.49). CONCLUSION: The prevention of AKI appeared predominantly responsible for the mortality benefit of radial as compared with femoral access in the MATRIX trial. There was little evidence for an equally important, independent role of bleeding.

Original languageEnglish
Pages (from-to)1226-1232
Number of pages7
JournalEuropean Heart Journal
Volume40
Issue number15
DOIs
Publication statusPublished - Apr 14 2019

Keywords

  • Acute coronary syndrome
  • Competing risk model
  • Multistate model
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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