Author + information
- Maziar Sadri,
- Gurpreet Sodhi,
- Ali Bou-Shahri,
- Bianca Ummat,
- Mink Chawla,
- Jonathan S. Reiner and
- Ramesh Mazhari
Acute Kidney Injury (AKI) is an important complication following cardiac catheterization, and it is not only the result of contrast medium exposure. Contrast independent factors such as atheroembolic phenomenon as a result of instrumentation of the abdominal aorta contribute to the development of AKI. Trans-radial cardiac catheterization has been shown to reduce the access site related bleeding complications. Trans-radial cardiac catheterization eliminates the passage of catheters via the abdominal aorta and can potentially reduce the incidence of AKI. In this study, we compare the incidence of AKI between trans-femoral and trans-radial approach.
Retrospective analysis of 2922 femoral and radial cardiac catheterizations at George Washington University hospital from 7/1/2009 to 12/30/2011 was performed. We then included patients who had elective and urgent cardiac catheterization and had follow up serum creatinine up to 7 days following cardiac catheterization. AKI was defined as rise of serum creatinine => 0.5 mg/dl from baseline up to 7 days after procedure. Other variables including hypertension, diabetes, age, gender, race, contrast volume, hypotension, smoking, hyperlipidemia, peripheral vascular disease, hematocrit, congestive heart failure, use of mechanical support devices (intra-aortic balloon pump or Impella) were collected.
A total of 636 cases of elective and emergent cardiac catheterizations were studied (57% trans-femoral, 42% trans-radial). The incidence of AKI was reduced in the trans-radial cohort, but the difference was not statistically significant when corrected for Mehran score in a multivariate logistic regression (P=0.9). In the subgroup with acute coronary syndrome (n=232), the incidence of AKI was significantly reduced in the trans-radial group (1% in the trans-radial group vs 9% in trans-femoral group, P<0.05) despite comparable mean contrast volume (204cc in femoral and 189cc in radial group) and correction for Mehran score.
Trans-radial catheterization is a safer alternative to trans-femoral approach and in addition to reducing the bleeding complications, it can also reduce the risk of AKI in patients with acute coronary syndrome.
- 2013 American College of Cardiology Foundation