title: Association of radial versus femoral access with contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.
abstract: BACKGROUND
  Patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are at an increased risk of developing contrast-induced acute kidney injury (CI-AKI). Data on the association between transradial (TRA) vs. transfemoral (TFA) access and the risk of CI-AKI in this setting are limited.
  
  
  METHODS
  We analyzed data on 1162 patients undergoing primary PCI for STEMI at two tertiary care centers between 2010 and 2014. Primary outcome was CI-AKI, defined as a relative rise in serum creatinine of ≥25%, or an absolute increase of ≥0.5mg/dL, within 48h of primary PCI. We used multivariable logistic regression and propensity analysis to determine the association between vascular access site and CI-AKI.
  
  
  RESULTS
  Of 1162 patients who underwent primary PCI for STEMI, TFA was used in 857 (73.8%), and TRA in 305 (26.2%) patients. In the unmatched cohort, TRA was associated with numerically lower rates of CI-AKI as compared with TFA; however, this difference did not reach statistical significance (5.9% vs. 7.0%; unadjusted OR 0.83, 95%CI 0.48-1.44, p=0.510; adjusted OR 0.84, 95%CI 0.44-1.62, p=0.610). Similar results were seen in a propensity matched cohort of 508 patients (254 TRA and 254 TFA; CI-AKI 5.5% vs. 8.3%, OR 0.65, 95% CI 0.32-1.30, p=0.220).
  
  
  CONCLUSIONS
  In patients with STEMI undergoing primary PCI, TRA was not associated with a lower risk of CI-AKI, as compared with TFA. Randomized controlled trials are needed to definitely assess the role of vascular access site in reducing the risk of CI-AKI in patients undergoing primary PCI for STEMI.
  
  
  CONCLUSIONS
  In patients with STEMI undergoing primary PCI, the overall incidence of contrast-induced acute kidney injury (CI-AKI) was low (6.7%). Transradial access was not associated with a lower risk of CI-AKI as compared with transfemoral access.
authors: Division of Cardiology, Brown University, Providence, RI.
authors: Dhaval
authors: D
authors: Kolte
authors: Department of Medicine, Brown University, Providence, RI.
authors: Nathan
authors: N
authors: Spence
authors: Department of Medicine, Brown University, Providence, RI.
authors: Mohamedtauqir
authors: M
authors: Puthawala
authors: Division of Cardiology, Brown University, Providence, RI.
authors: Omar
authors: O
authors: Hyder
authors: Department of Medicine, Brown University, Providence, RI.
authors: Christopher P
authors: CP
authors: Tuohy
authors: Department of Medicine, Brown University, Providence, RI.
authors: Carolyn B
authors: CB
authors: Davidson
authors: Division of Cardiology, University of New Mexico, Albuquerque, NM.
authors: Mark W
authors: MW
authors: Sheldon
authors: Division of Cardiology, University of New Mexico, Albuquerque, NM.
authors: Warren K
authors: WK
authors: Laskey
authors: Division of Cardiology, Brown University, Providence, RI. Electronic address: JAbbott@Lifespan.org.
authors: J Dawn
authors: JD
authors: Abbott
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009516:New Mexico; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D011237:Predictive Value of Tests; D057216:Propensity Score; D011677:Punctures; D017534:Radial Artery / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012237:Rhode Island; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine
keywords: Acute kidney injury; Percutaneous coronary intervention; Radial artery; ST-elevation myocardial infarction