title: Impact of vascular access on acute kidney injury after percutaneous coronary intervention.
abstract: OBJECTIVE
  We performed a systematic review of the literature and a meta-analysis to examine the role of access site in affecting the incidence of acute kidney injury (AKI) after percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  The vascular access site may play a central role among procedure-related risk factors for AKI after PCI. Transradial access is associated with reduced vascular complications and major bleeding which, in turn, is an emerging risk factor for post-procedural AKI.
  
  
  METHODS
  Results of six observational studies, three out of six providing propensity matching adjustment, of patients undergoing PCI from the radial and the femoral access were pooled, including overall 26,185 patients. The endpoint was the incidence of study-defined AKI. A meta-regression analysis was performed to further assess the role of study-level covariates. Random-effects models were privileged.
  
  
  RESULTS
  There was a significant difference in the incidence of AKI after PCI, favoring radial access (odds ratio [OR] 0.51, 95% CI 0.39-0.67, p<0.0001), and the effect size was larger in studies including only patients presenting with ST-elevation myocardial infarction (STEMI) (OR 0.42, 95% CI 0.24-0.72, p=0.001). The meta-regression showed a significant relationship between the benefit of radial access and the proportion of STEMI patients (p=0.031) in each of the included studies.
  
  
  CONCLUSIONS
  Transradial intervention is associated with a reduction in the incidence of AKI after PCI, as compared to the femoral access, and this benefit is more evident in STEMI patients. These findings warrant further confirmation in randomized controlled trials.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Italy. Electronic address: giuseppeando1975@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Andò
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Italy; Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Francesco
authors.initials: F
authors.lastname: Costa
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Italy.
authors.forename: Olimpia
authors.initials: O
authors.lastname: Trio
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Oreto
authors.affiliation: Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000517:prevention & control*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D005263:Femoral Artery; D006470:Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D065840:Protective Factors; D011677:Punctures; D017534:Radial Artery; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Acute kidney injury; Percutaneous coronary intervention; ST-elevation myocardial infarction; Transradial intervention