title: Acute kidney injury after percutaneous coronary intervention: Rationale of the AKI-MATRIX (acute kidney injury-minimizing adverse hemorrhagic events by TRansradial access site and systemic implementation of angioX) sub-study.
abstract: Acute kidney injury (AKI) is an important complication of both diagnostic cardiac catheterization and percutaneous coronary intervention (PCI). A large body of evidence supports that AKI is related to volume of contrast used. Despite several measures are available to reduce the impact of contrast media on AKI, its incidence remains significant as other mechanisms of renal damage are involved. A new paradigm is established according to which bleeding prevention is at least as important as preventing recurrent ischemic events in the management of patients with acute coronary syndromes (ACS) undergoing an invasive approach. Periprocedural bleeding, which is consistently reduced by radial approach, is emerging as a risk factor for the development of AKI. Therefore, the role of vascular access as a measure to prevent AKI needs to be systematically assessed in randomized studies. To date, no prospective comparison on renal outcomes has been carried out in randomized trials between radial and femoral approach. The Minimizing Adverse hemorrhagic events by TRansradial access site and systemic Implementation of AngioX (MATRIX) trial (ClinicalTrials.gov identifier: NCT01433627) has been designed to test whether to minimize bleeding events by using radial access and bivalirudin, across the whole spectrum of patients with ACS undergoing PCI, will result in improved outcomes with respect to both ischemic and bleeding complications. The AKI-MATRIX sub-study will provide a unique opportunity to assess whether the advantages of radial approach may even contribute to the reduction of the risk of AKI in patients with ACS.
authors: Department of Clinical and Experimental Medicine and Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino", University of Messina, Messina, Italy.
authors: Giuseppe
authors: http://orcid.org/0000-0001-5552-6382
authors: G
authors: Andò
authors: Ospedale Fatebenefratelli, Milan, Italy.
authors: Bernardo
authors: B
authors: Cortese
authors: EUSTRATEGY Association, Forlì, Italy.
authors: Enrico
authors: E
authors: Frigoli
authors: Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3, Turin, Italy.
authors: Andrea
authors: A
authors: Gagnor
authors: A.O. Ospedale Civile di Vimercate (MB), Vimercate, Italy.
authors: Stefano
authors: S
authors: Garducci
authors: Clinica Mediterranea, Naples, Italy.
authors: Carlo
authors: C
authors: Briguori
authors: Department of Cardiology, ASL3 Ospedale Villa Scassii, Genova, Italy.
authors: Paolo
authors: P
authors: Rubartelli
authors: Division of Cardiology, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
authors: Paolo
authors: P
authors: Calabrò
authors: Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands.
authors: Marco
authors: M
authors: Valgimigli
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D000991:Antithrombins / Q000008:administration & dosage* / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002985:Clinical Protocols; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006629:Hirudins / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D010446:Peptide Fragments / Q000008:administration & dosage* / Q000009:adverse effects; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D011677:Punctures; D017534:Radial Artery / Q000000981:diagnostic imaging; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012107:Research Design; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D003287:Contrast Media; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: acute coronary syndromes; acute kidney injury; contrast-induced nephropathy; percutaneous coronary intervention; transradial intervention