Feldkamp T, et al. - This study investigated if cardiac catheterization via radial access confers protection against the development of post-procedural contrast-induced nephropathy. Findings reported that cardiac catheterization using radial access versus femoral access bears significantly lower risk of acute kidney injury (AKI). This could partly explain the advantage of radial access in acute coronary syndrome regarding morbidity and mortality. Overall, radial access should be preferred in patients at risk for AKI.

Methods

• Researchers performed a retrospective monocentric analysis including 2937 patients that had undergone cardiac catheterization.
• In their hospital, coronary intervention was performed primarily via the femoral artery up to 2013; thereafter, interventions were primarily done via the radial artery.

Results

• Data reported that 1141 patients had received catheterization using the radial access while 1796 were examined via the femoral artery.
• Regarding the amount of iodinated contrast medium applied, there were no significant differences between the two groups [femoral group: 180 (120–260) ml; radial group: 180 (120–250) ml;P = 0.438].
• Findings revealed that acute kidney injury (AKI) occurred in a total of 400 (13.6%) patients post- cardiac catheterization (85.3% AKI stage 1; 12.8% AKI stage 2; 2% AKI stage 3).
• Researchers noted that in patients that had received radial access versus femoral access, AKI was significantly less frequent (10.1 vs. 15.9%, P < 0.001).
• As demonstrated in multivariate regression analysis, following were the important risk factors for the occurrence of AKI: patient age (1.03/year; 95% CI 1.02–1.04/year; P < 0.001), the amount of contrast media applied (OR 1.003/ml; 95% CI 1.002–1.004/ml; P < 0.001), acute coronary syndrome (OR 2.01, 95% CI 1.52–2.66; P < 0.001), CKD (OR 1.62, 95% CI 1.50–1.70; P < 0.001), pre-existing heart failure (OR 1.27, 95% CI 1.00–1.42 P = 0.007), previous myocardial infarction (OR 1.34, 95% CI 1.15–1.49; P = 0.001), diabetes (OR 1.25, 95% CI 1.04–1.41; P = 0.020) and serum creatinine before the procedure (1.45/mg/dl; 95% CI 1.24–1.69/mg/dl; P < 0.001).
• This analysis pointed to a significant risk reduction using radial access (OR 0.65; 95% CI 0.51–0.83; P < 0.001).
• Interestingly, CKD patients also had this risk reduction (OR 0.59; 95% CI 0.41–0.87; P = 0.007).
• Researchers observed that the superiority of radial access was particularly obvious in the subgroup of patients with acute coronary syndrome (13.1% AKI in the radial access group vs. 23.6% AKI in the femoral access group, OR 0.52; 95% CI 0.34–0.81; P = 0.003).