Abstract 15644: Does Radial Access Reduce the Risk of Contrast Induced Nephropathy in Patients undergoing Percutaneous Coronary Interventions: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)
Introduction: Contrast induced nephropathy (CIN) post percutaneous coronary interventions (PCI) is a multi-causal phenomenon which might be influenced by vascular access site. We compared risks of CIN and nephropathy requiring dialysis (NRD) between transradial (TRA) and transfemoral (TFA) PCI.
Methods: Our study comprised consecutive patients undergoing emergent or elective TRA or TFA between 2010 and 2012 across 47 hospitals in Michigan. Primary endpoint was CIN (serum creatinine increase > 0.5 mg/dL). Secondary endpoints were NRD and post procedural bleeding. Study endpoints were calculated for the entire and a propensity matched population, with odds ratios (OR) reported as crude and adjusted values for preprocedural calculated risk of CIN.
Results: In total, 82,225 PCI procedures were performed of which 8915 were TRA. After adjusting for baseline differences, TRA was associated with a reduction in CIN (OR 0.76, 95% CI 0.62 -0.92, P = 0.004) and bleeding with a trend towards lower NRD risk in the entire population. The propensity matched population consisted of 17,716 procedures, 8,857 for both groups. In the propensity matched population, TRA was associated with lower adjusted odds of CIN (OR 0.74, 95% CI, 0.58-0.96,P = 0.02), and bleeding (OR 0.47, 95% CI 0.36-0.63, P <0.001) but no difference in NRD (figure). Although post procedural bleeding was independently associated with CIN (OR 2.86, 95% CI 1.75-4.66, p<0.001) in the propensity matched population, the lower odds of CIN was not mediated by a lower bleeding risk with TRA.
Conclusions: The risk of CIN was significantly lower after TRA compared with TFA. While these data suggest a further safety advantage of TRA, this finding needs to be explored in randomized controlled trials.
- © 2013 by American Heart Association, Inc.