Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino", Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Division of Clinical Cardiology, A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy; Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
Catheter Cardiovasc Interv. 2018 Dec 1;92(7):E518-E526. doi: 10.1002/ccd.27903. Epub 2018 Sep 23.
We sought to investigate the impact of radial vs femoral access on the incidence of acute kidney injury (AKI) after coronary angiography or intervention.
There is a growing recognition of the importance of access site selection as an adjudicative measure to mitigate the risk of renal impairment for patients with coronary artery disease undergoing angiography with or without percutaneous coronary intervention.
We conducted a systematic review of the literature and meta-analyzed available evidence comparing the rates of AKI with radial vs femoral access in patients undergoing coronary angiography or intervention. Studies reporting the incidence of AKI as a primary or secondary outcome were pooled in fixed- and random-effects meta-analyses and meta-regression techniques were used to account for across-study heterogeneity.
Across data pooled from nine studies (n = 32 181), radial access was significantly associated with a reduction in the incidence of AKI (OR 0.57, 95% CI 0.50 to 0.66, P < 0.0001 with fixed-effects model, OR 0.55, 95% CI 0.45 to 0.67, P < 0.0001 with random-effects model) as compared to femoral. In the meta-regression model, the effect size of radial access effect was related to the number of centers in which studies were conducted.
Compared with the femoral approach, radial access was associated with a lower incidence of AKI after coronary angiography or intervention, although this benefit was less pronounced in multicenter than in single-center studies.
我们旨在研究经桡动脉与股动脉入路对冠状动脉造影或介入治疗后急性肾损伤（AKI）发生率的影响。
越来越多的人认识到，选择入路部位作为一种裁决措施对于减少接受冠状动脉造影或介入治疗的冠心病患者发生肾损伤的风险非常重要。
我们对文献进行了系统评价，并对比较经桡动脉与股动脉入路行冠状动脉造影或介入治疗患者 AKI 发生率的现有证据进行了荟萃分析。将报告 AKI 发生率为主要或次要结局的研究汇总到固定效应和随机效应荟萃分析中，并使用荟萃回归技术来解释研究间的异质性。
从 9 项研究（n = 32181 例）汇总的数据中发现，与股动脉入路相比，桡动脉入路显著降低 AKI 的发生率（OR 0.57，95% CI 0.50 至 0.66，P < 0.0001，固定效应模型；OR 0.55，95% CI 0.45 至 0.67，P < 0.0001，随机效应模型）。在荟萃回归模型中，桡动脉入路效果的效应大小与开展研究的中心数量有关。
与股动脉入路相比，经桡动脉入路与冠状动脉造影或介入治疗后 AKI 的发生率较低相关，尽管在多中心研究中这种获益不如在单中心研究中明显。
