In patients with acute coronary syndrome (ACS) undergoing invasive management, radial access may be associated with a reduced risk of acute kidney injury (AKI) compared to femoral access, according to results of the AKI–MATRIX trial published May 18 in the Journal of the American College of Cardiology and presented at EuroPCR conference in Paris.

Giuseppe Andò, MD, et al., examined 8,210 patients enrolled in the MATRIX–Access trial between October 2011 and July 2014. Half were assigned to radial access and half to femoral access. Baseline demographics and procedural characteristics were similar for the two groups.

Results showed that AKI occurred in 1,345 patients (16.4 percent), per the primary endpoint as defined by a relative (>25 percent) increase in serum creatinine and in 387 patients (4.7 percent) according to an absolute increase in serum creatinine of >0.5 mg/dl. Patients with AKI were older, more frequently female and had a higher prevalence of diabetes and anemia. They were also more likely to have presented with ST–segment elevation myocardial infarction (STEMI) and advanced Killip class and their access site crossover rate was twice as frequent.

Peak serum creatinine after intervention or at discharge did not differ in radial access vs. femoral access, but estimated glomerular filtration rate lower in the femoral group during hospitalization and at follow–up. AKI occurred in 15.4 percent of radial patients compared to 17.4 percent of femoral patients. There was a >25 percent increase in serum creatinine was observed in 633 (15.4 percent) radial access patients and 710 (17.3 percent) femoral access patients , and a >0.5 mg/dl absolute increase in serum creatinine occurred in 175 (4.3 percent) radial access patients and 223 (5.4 percent) femoral access patients (5.4 percent). Post–intervention dialysis occurred in fewer patients with radial access than femoral access.

The authors note that moving forward, future studies should evaluate if the use of radial access in patients with advanced chronic kidney disease affects or prevents a conduit for fistula for dialysis.

"This analysis of the MATRIX trial suggests that radial access is beneficial in preventing AKI after coronary angiography or intervention," write Sanjit S. Jolly, MD, and Ashraf Alazzoni, MD, in an accompanying editorial. "This provides another piece of evidence supporting a radial first approach in patients with ACS who are undergoing coronary angiography or intervention."