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 ≥0.5 mg/dL, within 48 h 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. Summary 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.