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Acute Kidney Injury (AKI) is a well-documented complication after cardiac catheterization and percutaneous coronary interventions (PCI). Compared to the femoral (TF) approach, transradial (TR) access has been associated with lower incidence of chronic kidney disease (CKD). We assessed the incidence of AKI and its association with arterial access after cardiac catheterization or PCI.
A total of 1,637 consecutive adult patients underwent cardiac catheterization or PCI at a single center between April 1, 2009 and September 30, 2012. AKI was defined as a rise in serum creatinine >0.5 mg/dl or 50% from the baseline value. Choice of arterial access was at the discretion of the operator. The independent effect of arterial access on AKI was evaluated using multivariable analysis.
TF and TR were used in 641 (39%) and 996 (61%) patients, respectively. In the TF and TR groups, the median age was 62 and 60 years (p=0.01), male gender was present in 37% and 63% (p=0.01), and median BMI was 29.7 and 29.9 kg/cm2(p=0.35), respectively. The total contrast volume (ml) was 165 vs. 180 (p<0.001) in TF and TR procedures, respectively. The GFR was greater than 60 mL/min/1.73 m2in 72% and 84% of TF and TR patients (p<0.001), respectively. The overall incidence of AKI was 3.6% (4.5% for TF and 2.5% for TR, p<0.001). After multivariable analysis adjusting for potential confounders, TF access had a trend towards increased AKI risk [OR=1.53, 95% CI 0.83 to 2.84, p=0.169].
Our results suggest that despite increased contrast volume use, TR access was not associated with an increased risk of AKI in a large cohort of patients undergoing cardiac catheterization and intervention procedures. The effect of TR access on the incidence of AKI should be further prospectively studied.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: AMI and PCI II
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1199-91
- 2013 American College of Cardiology Foundation