title: Comparison of risk of acute kidney injury after primary percutaneous coronary interventions with the transradial approach versus the transfemoral approach (from the PRIPITENA urban registry).
abstract: The risk of acute kidney injury (AKI) is a major issue after percutaneous coronary interventions (PCIs), especially in the setting of ST-elevation myocardial infarction. Preliminary data from large retrospective registries seem to show a reduction of AKI when a transradial (TR) approach for PCI is adopted. Little is known about the relation between vascular access and AKI after emergent PCI. We here report the results of the Primary PCI from Tevere to Navigli (PRIPITENA), a retrospective database of primary PCI performed at high-volume centers in the urban areas of Rome and Milan. Primary end point of this study was the occurrence of AKI in the TR and transfemoral (TF) access site groups. Secondary end points were major adverse cardiovascular events, stent thrombosis, and Thrombolysis in Myocardial Infarction major and minor bleedings. The database included 1,330 patients, 836 treated with a TR and 494 with a TF approach. After a propensity-matched analysis performed to exclude possible confounders, we identified 450 matched patients (225 TR and 225 TF). The incidence of AKI in the 2 matched groups was lower in patients treated with TR primary PCI (8.4% vs 16.9%, p = 0.007). Major adverse cardiovascular events and stent thrombosis were not different among study groups, whereas major bleedings were more often seen in the TF group. At multivariate analysis, femoral access was an independent predictor of AKI (odds ratio 1.654, 95% confidence interval 1.084 to 2.524, p = 0.042). In conclusion, in this database of primary PCI, the risk of AKI was lower with a TR approach, and the TF approach was an independent predictor for the occurrence of this complication.
authors: Interventional Cardiology, A.O. Fatebenefratelli Milano, Milano, Italy. Electronic address: bcortese@gmail.com.
authors: Bernardo
authors: B
authors: Cortese
authors: Interventional Cardiology, Sandro Pertini Hospital, Roma, Italy.
authors: Alessandro
authors: A
authors: Sciahbasi
authors: Interventional Cardiology, A.O. Fatebenefratelli Milano, Milano, Italy.
authors: Rodrigo
authors: R
authors: Sebik
authors: Interventional Cardiology, Sandro Pertini Hospital, Roma, Italy.
authors: Stefano
authors: S
authors: Rigattieri
authors: Interventional Cardiology, Sant'Andrea Hospital, University La Sapienza, Roma, Italy.
authors: Alessandro
authors: A
authors: Alonzo
authors: Interventional Cardiology, A.O. Fatebenefratelli Milano, Milano, Italy.
authors: Pedro
authors: P
authors: Silva-Orrego
authors: Cardiology, Santo Spirito Hospital, Roma, Italy.
authors: Flavia
authors: F
authors: Belloni
authors: Interventional Cardiology, A.O. Fatebenefratelli Milano, Milano, Italy.
authors: Romano G
authors: RG
authors: Seregni
authors: Interventional Cardiology, Sant'Andrea Hospital, University La Sapienza, Roma, Italy.
authors: Francesca
authors: F
authors: Giovannelli
authors: Interventional Cardiology, Ospedale Bolognini, Seriate, Italy.
authors: Maurizio
authors: M
authors: Tespili
authors: Cardiology, Santo Spirito Hospital, Roma, Italy.
authors: Roberto
authors: R
authors: Ricci
authors: Interventional Cardiology, Sant'Andrea Hospital, University La Sapienza, Roma, Italy.
authors: Andrea
authors: A
authors: Berni
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D011379:Prognosis; D017534:Radial Artery; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012384:Rome / Q000453:epidemiology