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AKI-MATRIX: PCI with radial access reduces risk for acute kidney injury vs. femoral access
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The use of radial access compared with femoral access was linked to reduced incidence of postprocedural acute kidney injury in patients with ACS who underwent invasive management, according to a presentation at EuroPCR.
“Among patients with ACS who were managed invasively, the use of [radial access] was significantly associated with a reduced occurrence of [acute kidney injury] compared with [femoral access],” study presenter Bernardo Cortese, MD, from the department of medicine at Ospedale Fatebenefratelli in Milan, and colleagues wrote in the study, which was simultaneously published in the Journal of the American College of Cardiology.
The AKI-MATRIX study was part of MATRIX-Access, a randomized, multicenter, superiority trial comparing radial access with femoral access in patients with ACS undergoing planned coronary angiography via radial or femoral access. The primary endpoint of AKI-MATRIX was acute kidney injury, defined as an absolute (> 0.5 mg/dL) or a relative (> 25%) increase in serum creatinine.
The researchers enrolled 8,404 patients in 78 centers in Italy, the Netherlands, Spain and Sweden between 2011 and 2014.
Acute kidney injury occurred in 634 patients (15.4%) with radial access and 712 patients (17.4%) with femoral access (OR = 0.87; 95% CI, 0.77-0.98).
According to the researchers, there was a greater than 25% increase in serum creatinine in 633 patients (15.4%) with radial access and 710 patients (17.3%) with femoral access (OR = 0.87; 95% CI, 0.77-0.98), whereas a greater than 0.5 mg/dL absolute serum creatinine increase occurred in 175 patients (4.3%) from the radial access group vs. 223 patients (5.4%) in the femoral access group (OR = 0.77; 95% CI, 0.63-0.95).
By implementing the Kidney Disease: Improving Global Outcomes criteria, Cortese and colleagues found that acute kidney injury was threefold less prevalent and trended lower with radial access (OR = 0.85; 95% CI, 0.7-1.03), with stage 3 acute kidney injury occurring in 28 patients (0.68%) with radial access vs. 46 patients (1.12%) with femoral access (P = .0367).
Six patients needed postintervention dialysis (0.15%) with radial access compared with 14 patients (0.34%) with femoral access (P = .0814).
In a related editorial, Sanjit S. Jolly, MD, and Ashraf Alazzoni, MD, both from the McMaster University and the Population Health Research Institute, Hamilton Health Sciences in Hamilton, Ontario, wrote: “This analysis of the MATRIX trial suggests that radial access is beneficial in preventing [acute kidney injury] after coronary angiography or intervention. This provides another piece of evidence supporting a radial-first approach in patients with [ACS] who are undergoing coronary angiography or intervention. – by Dave Quaile
References:
Cortese B, et al. PCI: Procedural techniques and clinical outcomes – Sessions comprising selected EuroPCR 2017 late-breaking trial submissions. Presented at: EuroPCR; May 16-19, 2017; Paris.
Andò G, et al. J Am Coll Cardiol. 2017;doi:10.1016/j.jacc.2017.02.070.
Jolly SS, Alazzoni. J Am Coll Cardiol. 2017;doi:10.1016/j.jacc.2017.02.071.
Disclosure: Alazzoni reports no relevant financial disclosures. Cortese reports receiving institutional research grant support from AB Medical; honoraria from Amgen, Hexacath and Stentys; and consultant fees from Aachen Resonance, Abbott Vascular, AstraZeneca, Innova, Kardia and Stentys. Jolly reports receiving grant support from Boston Scientific and Medtronic.
Perspective
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David J. Moliterno, MD, FACC
In this study, the researchers looked at patients who were having radial vs. femoral access with particular interest in development of acute kidney injury. Those patients, probably for reasons related to contrast and/or embolization, had better outcomes when the access was by the radial artery.
I think [the issue] comes up in a small subset of patients with a concern for acute kidney injury. In those cases, we try to minimize contrast and optimize the patients’ intravascular volume as best as possible, but this was a slightly different take on that: not passing catheters across the renal arteries, per se, but just using the radial access to avoid that.
The results have some implications for clinical practice, particularly in the U.S., because we’re still slightly behind the rest of the world with regard to radial artery access.
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