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Association of acute kidney injury and bleeding events with mortality after radial or femoral access in patients with acute coronary syndrome undergoing invasive management: secondary analysis of a randomized clinical trial.
Journal article

Association of acute kidney injury and bleeding events with mortality after radial or femoral access in patients with acute coronary syndrome undergoing invasive management: secondary analysis of a randomized clinical trial.

  • Rothenbühler M CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, Bern, Switzerland.
  • Valgimigli M Swiss Cardiovascular Center Bern, Bern University Hospital, Freiburgstrasse 8, Bern, Switzerland.
  • Odutayo A Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada.
  • Frigoli E CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, Bern, Switzerland.
  • Leonardi S Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, Pavia, Italy.
  • Vranckx P Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium, and Faculty of Medicine and Life Sciences, University of Hasselt, Martelarenlaan 42, Hasselt, Belgium.
  • Turturo M Division of Cardiology, P.O. Di Venere, Via Ospedale di Venere 1, Bari, Italy.
  • Moretti L Division of Cardiology, Mazzoni Hospital, Via Degli Iris, Ascoli Piceno, Italy.
  • Amico F Cardiology Unit, S. Elia Hospital, Via Luigi Russo 6, Caltanissetta, Italy.
  • Uguccioni L Interventional Cardiology, Ospedali Riuniti Marche Nord, Piazzale Cinelli 4, Pesaro, Italy.
  • Contarini M Interventional Cardiology Unit, Umberto I Hospital, Via Testaferrata 1, Siracusa, Italy.
  • Gómez-Hospital JA Heart Diseases Institute, Bellvitge University Hospital, Feixa Llarga s/n, L'Hospitalet, Barcelona, Spain.
  • Mainar V Department of Cardiology, Hospital General of Alicante, Pintor Baeza 11, Alicante, Spain.
  • Creaco M Cardiology Unit, Gravina Hospital, Via Portosalvo 9, Caltagirone, Italy.
  • Petronio AS Unit of Interventional Cardiology, Cardiothoracic and Vascular Department, Ospedale di Cisanello, University of Pisa, Via Paradisa 2, Pisa, Italy.
  • Cremonesi A Cardiovascular Department, Humanitas Gavazzeni Hospital, Via M. Gavazzeni 21, Bergamo, Italy.
  • Tamburino C Cardiology Division, C.A.S.T. Policlinico University Hospital, Cardio-Thorax-Vascular and Transplant Department, Via S. Sofia 76, Catania, Italy.
  • Fresco C Cardiology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Piazzale S. Maria della Misericordia 15, Udine, Italy.
  • Bonmassari R Division of Cardiology, Santa Chiara Hospital, Largo Medaglie D'oro 9, Trento, Italy.
  • Díaz Fernández JF Interventional Cardiology Department, Juan Ramon Jimenez University Hospital, Ronda norte sn, Huelva, Spain.
  • Romagnoli E Department of Cardiology, Fondazione Policlinico Universitario A. Gemelli, Largo Agostino Gemelli 8, Rome, Italy.
  • Beyersmann J Institute of Statistics, Ulm University, Helmholtzstrasse 20, Ulm, Germany.
  • Heg D CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, Bern, Switzerland.
  • Jüni P Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada.
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  • 2019-01-29
Published in:
  • European heart journal. - 2019
Acute coronary syndrome
Competing risk model
Multistate model
Percutaneous coronary intervention
Acute Coronary Syndrome
Acute Kidney Injury
Case-Control Studies
Coronary Angiography
Femoral Artery
Hemorrhage
Humans
Percutaneous Coronary Intervention
Radial Artery
ST Elevation Myocardial Infarction
Treatment Outcome
English AIMS
In the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) trial, adults with acute coronary syndrome undergoing coronary intervention who were allocated to radial access had a lower risk of bleeding, acute kidney injury (AKI), and all-cause mortality, as compared with those allocated to femoral access. The mechanism of the mortality benefit of radial access remained unclear.


METHODS AND RESULTS
We used multistate and competing risk models to determine the effects of radial and femoral access on bleeding, AKI and all-cause mortality in the MATRIX trial and to disentangle the relationship between these different types of events. There were large relative risk reductions in mortality for radial compared with femoral access for the transition from AKI to death [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.31-0.97] and for the pathway from coronary intervention to AKI to death (HR 0.49, 95% CI 0.26-0.92). Conversely, there was little evidence for a difference between radial and femoral groups for the transition from bleeding to death (HR 1.05, 95% CI 0.42-2.64) and the pathway from coronary intervention to bleeding to death (HR 0.84, 95% CI 0.28-2.49).


CONCLUSION
The prevention of AKI appeared predominantly responsible for the mortality benefit of radial as compared with femoral access in the MATRIX trial. There was little evidence for an equally important, independent role of bleeding.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://folia.unifr.ch/global/documents/132056
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