CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 160 AFRICA Is the transradial approach associated with decreased acute kidney injury following percutaneous coronary intervention in patients not complicated by major bleeding and haemodynamic disturbance? Tolga Dasli, Burak Turan Abstract Background: The impact of the transradial approach (TRA) on the development of acute kidney injury (AKI) after percutaneous coronary interventions (PCI) has been controversial. Methods: We retrospectively analysed 463 patients undergoing PCI for either acute or chronic coronary syndrome. Excluded patients were those with missing laboratory or procedural data, acute/decompensated heart failure, major bleeding, haemodynamic instability, long-term dialysis and mortality. The primary endpoint of the study was the incidence of AKI after PCI, which was defined as an increase in serum creatinine (SCr) level of 0.5 mg/dl or 25% from the baseline. Secondary endpoints were change in SCr level, increase in SCr of ≥ 0.3 and ≥ 0.5 mg/dl, and increase in SCr of ≥ 25 and ≥ 50%. We compared the incidence of AKI between the TRA and the transfemoral approach (TFA) in the overall and a propensity score (PS)-matched study population. Results: The study population included 339 patients. After PS matching, we obtained a well-balanced population of 182 patients. The differences between the incidence of AKI in the TRA and TFA were not significant in both the overall (9.0 vs 11.2%, p = 0.503) and PS-matched (9.9 vs 7.7%, p = 0.601) study population. TRA resulted in a significantly lower incidence of SCr increase of ≥ 50% in unmatched patients. However, after PS matching, there was no difference between the TRA and TFA in any variable of secondary post-PCI renal outcomes. Age, female gender, baseline SCr level, baseline estimated glomerular filtration rate and contrast volume were independent predictors of AKI. Conclusion: Compared to the conventional TFA, TRA was not associated with a reduced incidence of AKI after PCI in patients not complicated by major bleeding, acute heart failure and haemodynamic disturbances. Keywords: acute kidney injury, contrast-induced nephropathy, percutaneous coronary intervention, transradial approach Submitted 20/1/23; accepted 25/4/23 Published online 5/6/23 Cardiovasc J Afr 2024; 35: 160–165 www.cvja.co.za DOI: 10.5830/CVJA-2023-025 Acute kidney injury (AKI) following cardiac intervention is associated with a poor short- and long-term prognosis. Depending on the definition and clinical setting, AKI can be observed in up to 25% of patients after cardiac interventions.1,2 Established clinical risk factors for AKI after cardiac procedures included patient-related risk factors (older age, chronic renal failure, diabetes, anaemia, heart failure, dehydration and use of nephrotoxic drugs) and procedure-related risk factors (contrast volume, choice of contrast agent and repeat procedure within 48–72 hours).3-5 Recently, it has been proposed that the transradial approach (TRA) might have a protective role against AKI.6-9 Aside from the usual procedural risk factors, atheroembolism from the abdominal aorta to the renal arteries is thought to be responsible for AKI during the transfemoral approach (TFA), as the abdominal aorta is not catheterised during radial procedures. However, the data have not been clear-cut so far. There are conflicting results on the benefit of the TRA on AKI,10-14 particularly when there is a strong negative relationship between TRA and bleeding events after percutaneous coronary interventions (PCI).11,12 To some extent, this might explain the lower incidence of AKI after a transradial intervention. In this article, we aimed to analyse our data to see whether the TRA had an advantage over TFA in reducing AKI following PCI. Methods Consecutive patients undergoing PCI between July 2016 and April 2018 in a tertiary centre were analysed retrospectively in this study. Both elective procedures and procedures for acute coronary syndromes (ACS) were included. Demographic, laboratory and clinical data were obtained from hospital records. The study was approved by the local institutional ethics committee. We opted to exclude major complications of ACS and/or PCI so that haemodynamics did not play a central role in the development of AKI. Patients presenting with haemodynamic instability or cardiogenic shock were excluded, as haemodynamic deterioration worsens renal perfusion and function, even without a PCI procedure. Systolic blood pressure below 90 mmHg persisting for more than 30 minutes was considered as haemodynamic instability. Patients with acute or decompensated heart failure were excluded. Similar to cardiogenic shock, the rapid development of heart failure in ACS causes renal malperfusion and dysfunction independent of intervention. Acute heart failure was diagnosed clinically by the attending cardiologist. Rapid onset or deterioration of previous symptoms and/or signs of heart failure were considered acute heart failure. Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey Tolga Dasli, MD Burak Turan, MD, drburakturan@gmail.com
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