Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan.
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Division of Cardiology, Vancouver General Hospital, Vancouver, Canada.
Cardiovasc Revasc Med. 2020 Sep;21(9):1138-1143. doi: 10.1016/j.carrev.2020.02.004. Epub 2020 Feb 12.
Multiple randomized clinical trials have demonstrated that transradial intervention (TRI) improves clinical outcomes after percutaneous coronary intervention (PCI) compared with transfemoral intervention (TFI). However, chronic kidney disease (CKD) patients have more procedure-related complications; TRI is frequently avoided for future creation of arteriovenous fistulas essential for hemodialysis. Therefore, limited information on TRI among CKD patients exists. We aimed to assess the impact of TRI on CKD patients.
Consecutive PCI patients with advanced CKD registered in a multicenter Japanese registry between 2008 and 2017 (N = 20,420) were analyzed. Advanced CKD was defined as estimated glomerular filtration rate <30 mL/min/1.73 m. Outcomes of interest were periprocedural bleeding (transfusion or decreasing hemoglobin by >3.0 g/dL within 72 h after PCI), acute kidney injury (AKI: absolute increase of 0.3 mg/dL or a relative increase of 50% in serum creatinine from baseline), and hemodialysis initiation after PCI. To account for baseline differences between patients with TRI and TFI, 1:1 propensity matching was performed.
Overall, 498 patients (3.7%) had advanced CKD, and 199 (40.0%) underwent TRI. After propensity matching, 324 patients were included (age, 74.9 ± 9.9 years; male, 63.6%; ACS, 46.0%). TRI was associated with reduced periprocedural AKI risks (12.4% versus 26.5%; p < 0.01) and hemodialysis initiation (3.1% versus 12.4%; p = 0.01) compared with TFI. TRI showed a trend toward lower rates of bleeding complications than those of TFI, but the difference was not statistically significant (1.9% versus 6.2%; p = 0.15).
TRI might be beneficial over TFI in PCI patients with advanced CKD.
多项随机临床试验表明，与经股动脉介入（TFI）相比，经桡动脉介入（TRI）可改善经皮冠状动脉介入治疗（PCI）后的临床结局。然而，慢性肾脏病（CKD）患者的手术相关并发症更多；为了将来为血液透析创建必要的动静脉瘘，经常避免进行 TRI。因此，关于 CKD 患者的 TRI 信息有限。我们旨在评估 TRI 对 CKD 患者的影响。
对 2008 年至 2017 年期间在日本多中心注册登记的接受高级 CKD 的连续 PCI 患者（N=20420）进行分析。高级 CKD 定义为估算肾小球滤过率<30mL/min/1.73m。研究的主要终点是围手术期出血（PCI 后 72 小时内需要输血或血红蛋白降低>3.0g/dL）、急性肾损伤（AKI：血清肌酐绝对值增加 0.3mg/dL 或基线值增加 50%）和 PCI 后开始血液透析。为了考虑到接受 TRI 和 TFI 的患者之间的基线差异，进行了 1:1 的倾向匹配。
总体而言，498 名患者（3.7%）患有高级 CKD，其中 199 名（40.0%）接受了 TRI。在倾向匹配后，共有 324 名患者入选（年龄，74.9±9.9 岁；男性，63.6%；ACS，46.0%）。与 TFI 相比，TRI 与围手术期 AKI 风险降低相关（12.4%比 26.5%；p<0.01），与 TFI 相比，血液透析的起始率也较低（3.1%比 12.4%；p=0.01）。TRI 与 TFI 相比，出血并发症的发生率较低，但差异无统计学意义（1.9%比 6.2%；p=0.15）。
在接受高级 CKD 的 PCI 患者中，TRI 可能优于 TFI。
