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

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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.

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Acknowledgements

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

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Authors and Affiliations

  1. Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan

    Toshiki Kuno, Shohei Imaeda, Kenji Hashimoto, Toshinobu Ryuzaki, Souichi Yokokura, Tetsuya Saito, Hiroyuki Yamazaki, Ryota Tabei, Masaki Kodaira & Yohei Numasawa

  2. Department of Medicine, Mount Sinai Beth Israel Medical Center, First Avenue, 16th Street, New York, NY, 10003, USA

    Toshiki Kuno

  3. Department of Nephrology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan

    Keita Hirano

  4. Department of Preventive Medicine and Public Health, Biostatistics at Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan

    Takayuki Abe

  5. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan

    Kenji Hashimoto, Toshinobu Ryuzaki & Tetsuya Saito

  6. Department of Cardiology, Kyorin University School of Medicine, Mitaka, Japan

    Hiroyuki Yamazaki

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  1. Toshiki Kuno
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  2. Keita Hirano
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Correspondence to Toshiki Kuno.

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Kuno, T., Hirano, K., Abe, T. et al. Trans-radial percutaneous coronary intervention for patients with severe chronic renal insufficiency and/or on dialysis. Heart Vessels 34, 1412–1419 (2019). https://doi.org/10.1007/s00380-019-01387-0

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