A meta-analysis of 22108 patients undergoing PCI: can radial approach reduce the incidence of acute kidney injury?

Aims: Risk factors for Acute Kidney Injury (AKI) after Percutaneous Coronary Intervention (PCI) include both patient- and procedure-related features. Among the latter, the selection of the vascular access site may play a role. Transradial access is associated with reduced access-site complications and major bleeding. Major bleeding is an emerging risk factor for post-procedural AKI. We performed a systematic revision of the literature and a meta-analysis to examine the role of access site in affecting the incidence of AKI after PCI. Methods and results: Five observational studies prospectively comparing patients undergoing PCI from the radial and the femoral access were selected, including overall 22,108 patients. The primary efficacy endpoint was the incidence of AKI. Random effects models were privileged. There was a statistically significant difference in the incidence of AKI after PCI, favoring radial access (Odds Ratio 0.49 with random effects model, Odds Ratio 0.57, with fixed effects model, both p<0.001). A meta-regression analysis showed a significant relationship between the benefit of radial access and the prevalence of major bleeding in each of the included studies (p<0.001). Conclusions: Transradial intervention seems to reduce the incidence of AKI after PCI, as compared to the femoral access, and this benefit might be mediated by the reduction in bleeding complications. This finding warrants further confirmation in randomised controlled trials.