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Rigattieri S, Cristiano E, Tempestini F, Pittorino L, Cesario V, Casenghi M, Giovannelli F, Tommasino A, Barbato E, Berni A. Acute Kidney Injury in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: The Role of Vascular Access Site. J Clin Med 2024; 13:2367. [PMID: 38673640 PMCID: PMC11051292 DOI: 10.3390/jcm13082367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Background: in patients undergoing percutaneous coronary interventions (PCI), radial access should be favoured over femoral access as it reduces the risk of vascular complications and bleeding. Furthermore, a preventive role of radial access in the occurrence of acute kidney injury (AKI), mainly mediated by the reduction of bleeding and cholesterol crystal embolization into renal circulation, has been investigated in several studies, yielding conflicting results. Methods: we designed a retrospective study to appraise the effect of the use of a vascular access site on the occurrence of AKI in a cohort of 633 patients with acute myocardial infarction treated by PCI at our centre from 2018 to 2020. Results: after propensity score adjustment, radial access was associated with a reduced, albeit statistically not significant, incidence of AKI (14.7% vs. 21.0%; p = 0.06) and major bleeding (12.5% vs. 18.7%; p = 0.04) as compared to femoral access. At multivariate analysis, femoral access was an independent predictor of AKI, together with in-hospital occurrence of BARC 3-5 bleeding, Killip class >1 at presentation, female gender, baseline eGFR <60 mL/min, and baseline haemoglobin <12 g/dL. Conclusions: although limited by the observational design, our study supports the hypothesis that radial access may exert a protective role on the occurrence of AKI in patients with acute myocardial infarction undergoing PCI.
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Affiliation(s)
- Stefano Rigattieri
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Ernesto Cristiano
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
- Department of Electrophysiology, Humanitas Gavazzeni, 24125 Bergamo, Italy
| | - Federica Tempestini
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Luca Pittorino
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Vincenzo Cesario
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Matteo Casenghi
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Francesca Giovannelli
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Antonella Tommasino
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
| | - Emanuele Barbato
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Berni
- Cardiology Division, Sant’Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; (E.C.); (F.T.); (L.P.); (V.C.); (M.C.); (F.G.); (A.T.); (E.B.); (A.B.)
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
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DE Rubeis G, Zilahi DE Gyurgyokai S, Fabiano S, Bertaccini L, Wlderk A, Pezzella FR, Anticoli S, Biondi-Zoccai G, Versaci F, Saba L, Pampana E. Intraprocedural continuous saline infusion lines significantly reduce the incidence of acute kidney injury during endovascular procedures for stroke and myocardial infarction: evidence from a systematic review and meta-regression. Minerva Med 2024; 115:151-161. [PMID: 38563606 DOI: 10.23736/s0026-4806.23.09093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Contrast media used in mechanical therapies for stroke and myocardial infarction represent a significant cause of acute kidney injury (AKI) in acute medical scenarios. Although the continuous saline infusion line (CSIL) is a standard procedure to prevent thrombus formation within the catheter during neurovascular interventions of mechanical thrombectomy (MT), it is not utilized in percutaneous coronary interventions (PCI). METHODS A systematic review of the incidence of AKI after MT for stroke treatment was performed. These data were compared with those reported in the literature regarding the incidence of AKI after PCI for acute myocardial infarction. A random-effect model meta-regression was performed to explore the effects of CSIL on AKI incidence, using clinical details as covariates. RESULTS A total of 18 and 33 studies on MT and PCI were included, respectively, with 69,464 patients (30,138 [43.4%] for MT and 39,326 [56.6%] for PCI). The mean age was 63.6 years±5.8 with male 66.6%±12.8. Chronic kidney disease ranged 2.0-50.3%. Diabetes prevalence spanned 11.1% to 53.0%. Smoking status had a prevalence of 7.5-72.0%. Incidence of AKI proved highly variable (I2=98%, Cochrane's Q 2985), and appeared significantly lower in the MT subgroup than in the PCI subgroups (respectively 8.3% [95% confidence interval: 4.7-11.9%] vs. 14.7 [12.6-16.8%], P<0.05). Meta-regression showed that CSIL was significantly associated with a decreased incidence of AKI (OR=0.93 [1.001-1.16]; P=0.03). CONCLUSIONS Implementation of CSIL during endovascular procedures in acute settings was associated with a significant decrease in the risk of AKI, and its safety should be routinely considered in such interventions.
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Affiliation(s)
- Gianluca DE Rubeis
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy -
| | | | - Sebastiano Fabiano
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Luca Bertaccini
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Andrea Wlderk
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Francesca R Pezzella
- UOSD Stroke Unit, Emergency Department, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Sabrina Anticoli
- UOSD Stroke Unit, Emergency Department, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Francesco Versaci
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari, Monserrato, Cagliari, Italy
| | - Enrico Pampana
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
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Lun Z, Mai Z, Liu L, Chen G, Li H, Ying M, Wang B, Chen S, Yang Y, Liu J, Chen J, Ye J, Liu Y. Hypertension as a Risk Factor for Contrast-Associated Acute Kidney Injury: A Meta-Analysis Including 2,830,338 Patients. Kidney Blood Press Res 2021; 46:670-692. [PMID: 34492656 DOI: 10.1159/000517560] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/01/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Previous studies have shown that the relationship between hypertension (HT) and contrast-associated acute kidney injury (CA-AKI) is not clear. We apply a systematic review and meta-analysis to assess the association between HT and CA-AKI. METHODS We searched for articles on the study of risk factors for CA-AKI in the Embase, Medline, and Cochrane Database of Systematic Reviews (by March 25, 2021). Two authors independently performed quality assessment and extracted data such as the studies' clinical setting, the definition of CA-AKI, and the number of patients. The CA-AKI was defined as a serum creatinine (SCr) increase ≥25% or ≥0.5 mg/dL from baseline within 72 h. We used fixed or random models to pool adjusted OR (aOR) by STATA. RESULTS A total of 45 studies (2,830,338 patients) were identified, and the average incidence of CA-AKI was 6.48%. There was an increased risk of CA-AKI associated with HT (aOR: 1.378, 95% CI: 1.211-1.567, I2 = 67.9%). In CA-AKI with a SCr increase ≥50% or ≥0.3 mg/dL from baseline within 72 h, an increased risk of CA-AKI was associated with HT (aOR: 1.414, 95% CI: 1.152-1.736, I2 = 0%). In CA-AKI with a Scr increase ≥50% or ≥0.3 mg/dL from baseline within 7 days, HT increases the risk of CA-AKI (aOR: 1.317, 95% CI: 1.049-1.654, I2 = 51.5%). CONCLUSION Our meta-analysis confirmed that HT is an independent risk factor for CA-AKI and can be used to identify risk stratification. Physicians should pay more attention toward prevention and treatment of patients with HT in clinical practice.
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Affiliation(s)
- Zhubin Lun
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, China.,Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
| | - Ziling Mai
- Guangdong Provincial People's Hospital, School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China
| | - Liwei Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Guanzhong Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial People's Hospital, School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China
| | - Huanqiang Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ming Ying
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bo Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yongquan Yang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jianfeng Ye
- The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, China.,Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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The global incidence and mortality of contrast-associated acute kidney injury following coronary angiography: a meta-analysis of 1.2 million patients. J Nephrol 2021; 34:1479-1489. [PMID: 34076881 PMCID: PMC8494686 DOI: 10.1007/s40620-021-01021-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/05/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Contrast-associated acute kidney injury (CA-AKI) is a common complication after coronary angiography (CAG), which brings a poor prognosis. But up to now, there were fewer studies to discuss the incidence of CA-AKI comprehensively. We comprehensively explore the incidence of CA-AKI after coronary angiography. METHODS We searched Medline, Embase, and Cochrane Database of Systematic Reviews (to 30th June 2019). We evaluated the world's incidence of the CA-AKI, and associated mortality, and to described geographic variations according to countries, regions, and economies. CA-AKI was defined as an increase in serum creatinine ≥ 0.5 mg/dl or ≥ 25% within 72 h. Random effects model meta-analyses and meta-regressions was performed to derive the sources of heterogeneity. RESULTS A total of 134 articles (1,211,106 participants) were included in our meta-analysis. Most studies originated from China, Japan, Turkey and United States, from upper middle income and high income countries. The pooled incidence of CA-AKI after coronary angiography was 12.8% (95% CI 11.7-13.9%), and the CA-AKI associated mortality was 20.2% (95% CI 10.7-29.7%). The incidence of CA-AKI and the CA-AKI associated mortality were not declined over time (Incidence rate change: 0.23% 95% CI - 0.050 to 0.510 p = 0.617; Mortality rate change: - 1.05% 95% CI - 3.070 to 0.970 p = 0.308, respectively). CONCLUSION CA-AKI was a universal complication in many regions, and the burden of CA-AKI remains severe. In clinical practice, physicians should pay more attention to the occurrence and active prevention and treatment of CA-AKI.
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Wang C, Chen W, Yu M, Yang P. Comparison of acute kidney injury with radial vs. femoral access for patients undergoing coronary catheterization: An updated meta-analysis of 46,816 patients. Exp Ther Med 2020; 20:42. [PMID: 32952633 PMCID: PMC7480164 DOI: 10.3892/etm.2020.9170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/17/2020] [Indexed: 01/06/2023] Open
Abstract
Trans-radial access for percutaneous coronary intervention or angiography has gained popularity amongst interventional cardiologists. Radial access is also thought to reduce the incidence of acute kidney injury (AKI) in the immediate post-operative period. The purpose of the present study was to perform a comprehensive updated systematic review and meta-analysis comparing the incidence of AKI following the radial vs. femoral route of coronary catheterization. An electronic literature search of the PubMed, BioMed Central, Scopus, Cochrane Central Register of Controlled Trials and Google Scholar databases up to 1st January 2020 was performed. A total of 14 studies were included, 2 of which were randomized controlled trials (RCTs), and 6 studies utilized propensity score matching. Comparison of the data of 21,479 patients in the radial group and 25,337 patients in the femoral group indicated a reduced incidence of AKI with the radial route [odds ratio (OR):0.66, 95% CI: 0.54-0.81, P<0.0001, I2=74%]. Similar results were obtained with sub-group analyses for RCTs (OR: 0.87, 95% CI: 0.77-0.98, P=0.02, I2=0%), retrospective studies (OR: 0.57, 95% CI: 0.36-0.90, P=0.02, I2=86%) and propensity score-matched studies (OR: 0.63, 95% CI: 0.48-0.83, P=0.0009, I2=45%). Multivariable-adjusted ORs of AKI for the radial vs. femoral route were extracted from non-RCTs and pooled for a meta-analysis, which also demonstrated similar results (OR: 0.70, 95% CI: 0.57-0.88, P=0.002, I2=70%). Within the limitations of the study, the present results indicate that, as compared to femoral access, the use of trans-radial access for coronary catheterization is associated with a significantly reduced incidence of AKI. A reduction of AKI by ~34% may be expected with the use of radial access.
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Affiliation(s)
- Chang Wang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130028, P.R. China
| | - Weiwei Chen
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130028, P.R. China
| | - Ming Yu
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130028, P.R. China
| | - Ping Yang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130028, P.R. China
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