Acute kidney injury - A european perspective. Comparison of risk of acute kidney injury following primary PCI with the transradial approach vs the transfemoral approach: The PRIPITENA Urban Registry.

1. AKI-a european perspective
Comparison of Risk of AKI Following Primary PCI with
the Transradial Approach vs the Transfemoral
Approach.
The PRIPITENA Urban Registry.
Cortese, Sciahbasi, Sebik, Rigattieri, Alonzo, Silva Orrego, Belloni, Seregni,
Giovannelli, Tespili, Ricci, Berni
Milano, Bergamo & Roma
Bernardo Cortese
Intv’ Cardiology, A.O. Fatebenefratelli
bcortese@gmail.com

2. Disclosure Statement of Financial Interest
Within the past 12 months, I or my spouse have had a financial
interest/arrangement or affiliation with the organizations listed
below.
Affiliation/Financial Relationship Company
• Grant/Research Support
• Consulting
Fees/Honoraria
• Advisory board
• Movi, AB Medica
• Cardionovum, Abbott
Vascular, Hexacath,
Astra Zeneca, Terumo
• Medtronic/Invatec

3. AKI: a PCI problem
1.000.000 PCIs (National CV Data Registry)
20-30% in pts with preexisting RI
Tsai TT, JACC Int ‘14
>1200 US hospitals
6.09-6.11
single PCI during hospitalization
AKI definition: >0.3 mg/dl or >50% increase Cr

4. AKI: a PCI problem
Tsai TT, JACC Int ‘14

5. Seeliger E, EHJ ‘12
AKI: a PCI problem

6. Kooiman J, Circ CI ‘14

7. The PRImary PCI from TEvere to NAvigli (PRIPITENA)
registry is a multicenter italian consortium of expert
primary PCI facilities from urban areas of Milano and
Roma.
The aim of our study was to evaluate, in the
setting of primary PCI, the role of different
vascular approaches for the occurrence of AKI
(cr  25% or 0,5 mg/dl).

8. All STEMI patients undergone
PPCI 2011-2013 w’in 12 hours
(1330)
TF
(494)
TR
(836)
occurrence of AKI (primary
unadjusted analysis)
propensity score matching:
occurrence of AKI (PE)
SE: MACE
bleeds (major & minor TIMI)
ST (ARC)
B. Cortese et al, Am J Cardiol 9 14

9. clinical data
B. Cortese et al, Am J Cardiol 9
14

10. AKI incidence:
8.1 vs. 16.9, p <0.0001
B. Cortese et al, Am J Cardiol 9
14

11. B. Cortese et al, Am J Cardiol 9
14

12. AKI incidence
8.4%
16.9%
B. Cortese et al, Am J Cardiol 9
14

13. B. Cortese et al, Am J Cardiol 9
14

14. >AKI with transfemoral:
why?
1-hypotension/hypovolemia due to bleeds
2-atheroembolism due to catheter
manipulation in abdominal aorta

15. AKI: a PCI problem
Stratta G, J Nephrol ‘12
CIN

16. study limitations
B. Cortese et al, Am J Cardiol 9
14
1- multicenter retrospective DB
2- different habits among centers
3- short follow up (in-hospital)

17. conclusions
this is the first report that shows a reduced
incidence of AKI with the transradial
approach vs the transfemoral one, in a high
risk population with STEMI.

18. AKI-a european perspective
Comparison of Risk of AKI Following Primary PCI with
the Transradial Approach vs the Transfemoral
Approach.
The PRIPITENA Urban Registry.
Cortese, Sciahbasi, Sebik, Rigattieri, Alonzo, Silva Orrego, Belloni, Seregni,
Giovannelli, Tespili, Ricci, Berni
Milano, Bergamo & Roma
Bernardo Cortese
Intv’ Cardiology, A.O. Fatebenefratelli
bcortese@gmail.com