Authors: Ahmed Gwefel, Osama Louis, Ihab Yassin.
Background: Contrast-induced nephropathy (CIN) continues to be one of the most common major adverse side effects of cardiac catheterization, and is associated with short- and long-term morbidity and mortality. Since the trans-radial approach to coronary angiography was first reported in 1989, trans-radial access has been used for primary percutaneous coronary intervention (PCI) for approximately 20 years. There is a growing perception that, within the setting of intra-arterial procedures, there is a different risk factor for renal involvement when using radial or femoral access, with femoral access leading to the greatest risk because of its proximity to the high flow bed of the renal arteries. This study aimed to compare the degree of renal dysfunction by different indices in trans-radial and trans-femoral primary PCI.
Materials and Methods: This study had been conducted in the cardiology department; the National Heart Institute during the period from September 2018 to February 2020. The study included 90 patients admitted to the hospital with acute myocardial infarction and underwent primary PCI either through a femoral or radial with the Cystatin C and serum creatinine measured before and 72 hours of primary PCI.
Results: A statistical difference between both groups regarding CIN, with p-value=0.044 was found. There was no statistical difference between both groups after PCI regarding serum creatinine and cystatin C with p-value: 0.723 and 0.439, respectively. Concerning serum urea, there was statistical difference between both groups after PCI in the direction to be more in the radial group: it was 28.46 ± 13.89 mg/dl in femoral group and 30.06 ± 7.99 mg/dl in radial group (p=0.003). However, time to vascular access was easier with femoral group than with radial group with p-value < 0.001. Regarding complications, there were no statistical difference between two groups except for hematoma (p-value=0.026)
Conclusion: The study showed significant results according to developing CIN between the two groups which is more in femoral approach. The study showed that serum cystatin C didn’t add value to diagnosis of CIN.
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