Impact of vascular access on acute kidney injury after percutaneous coronary intervention

Objectives. We performed a systematic review of the literature and a meta- analysis to examine the role of access site in affecting the incidence of Acute Kidney Injury (AKI) after Percutaneous Coronary Intervention (PCI). Background. The vascular access site may play a central role among procedure- related risk factors for AKI after PCI. Transradial access is associated with reduced vascular complications and major bleeding which, in turn, is an emerging risk factor for post-procedural AKI. Methods. Results of six observational studies, three out of six providing propensity matching adjustment, of patients undergoing PCI from the radial and the femoral access were pooled, including overall 26185 patients. The endpoint was the incidence of study-defined AKI. A meta-regression analysis was performed to further assess the role of study-level covariates. Random-effects models were privileged. Results. There was a significant difference in the incidence of AKI after PCI, favoring radial access (Odds Ratio [OR] 0.51, 95% CI 0.39-0.67, p<0.0001), and the effect size was larger in studies including only patients presenting with ST-elevation myocardial infarction (STEMI) (OR 0.42, 95% CI 0.24-0.72, p=0.001). The meta- regression showed a significant relationship between the benefit of radial access and the proportion of STEMI patients (p=0.031) in each of the included studies. Conclusions. Transradial intervention is associated with a reduction in the incidence of AKI after PCI, as compared to the femoral access, and this benefit is more evident in STEMI patients. These findings warrant further confirmation in randomized controlled trials.