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Trans-radial percutaneous coronary intervention for patients with severe chronic renal insufficiency and/or on dialysis

  • Toshiki KunoEmail author
  • Keita Hirano
  • Takayuki Abe
  • Shohei Imaeda
  • Kenji Hashimoto
  • Toshinobu Ryuzaki
  • Souichi Yokokura
  • Tetsuya Saito
  • Hiroyuki Yamazaki
  • Ryota Tabei
  • Masaki Kodaira
  • Yohei Numasawa
Original Article
  • 31 Downloads

Abstract

Periprocedural bleeding is associated with an increased risk of mortality during percutaneous coronary intervention (PCI), especially in patients with severe chronic renal insufficiency. Therefore, trans-radial intervention (TRI) should be considered in these patients; however, PCI operators usually avoid this approach because of the risk of radial artery occlusion. We aimed to investigate the associations of TRI and in-hospital complications in these patients. This study included 306 consecutive patients with severe chronic renal insufficiency and/or on dialysis who underwent PCI. Patients were prospectively enrolled and divided according to the access site into TRI group and trans-femoral intervention group. Severe renal insufficiency was defined as estimated glomerular filtration rate < 30 mL/min/1.73 m2. Radial access was limited to the opposite side of the arteriovenous fistula in patients on hemodialysis. The primary study endpoint was the composite of in-hospital bleeding complications and death. TRI benefit was evaluated by inverse probability treatment weighted analysis. TRI was performed in 112 (37.3%) patients. TRI group included older patients with significantly lower rates of diabetes mellitus, dialysis, and three-vessel disease. Crossover to the other approach occurred only in TRI group (2.6%). The primary endpoint was significantly lower in TRI group (11.5% vs. 2.6%, P = 0.006). After an inverse probability treatment weighted analysis, TRI was an independent prognostic factor for a decrease in the primary endpoint (OR 0.19; 95% CI 0.051–0.73; P = 0.015). Radial artery occlusion occurred in three patients on dialysis (9.1%). TRI may determine better in-hospital outcomes in patients with severe chronic renal insufficiency and/or on dialysis.

Keywords

Trans-radial approach Percutaneous coronary intervention Coronary artery disease Dialysis Renal insufficiency 

Notes

Acknowledgements

The authors thank the staffs of the cardiology wards and catheterization laboratory at Japanese Red Cross Ashikaga Hospital.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Toshiki Kuno
    • 1
    • 2
    Email author
  • Keita Hirano
    • 3
  • Takayuki Abe
    • 4
  • Shohei Imaeda
    • 1
  • Kenji Hashimoto
    • 1
    • 5
  • Toshinobu Ryuzaki
    • 1
    • 5
  • Souichi Yokokura
    • 1
  • Tetsuya Saito
    • 1
    • 5
  • Hiroyuki Yamazaki
    • 1
    • 6
  • Ryota Tabei
    • 1
  • Masaki Kodaira
    • 1
  • Yohei Numasawa
    • 1
  1. 1.Department of CardiologyJapanese Red Cross Ashikaga HospitalAshikagaJapan
  2. 2.Department of MedicineMount Sinai Beth Israel Medical CenterNew YorkUSA
  3. 3.Department of NephrologyJapanese Red Cross Ashikaga HospitalAshikagaJapan
  4. 4.Department of Preventive Medicine and Public Health, Biostatistics at Center for Clinical ResearchKeio University School of MedicineTokyoJapan
  5. 5.Department of CardiologyKeio University School of MedicineTokyoJapan
  6. 6.Department of CardiologyKyorin University School of MedicineMitakaJapan

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