Impact of contrast-induced acute kidney injury after percutaneous coronary intervention on short- and long-term outcomes: Pooled analysis from the HORIZONS-AMI and ACUITY trials

Daniele Giacoppo, Mahesh V. Madhavan, Usman Baber, Josephine Warren, Sameer Bansilal, Bernhard Witzenbichler, George D. Dangas, Ajay J. Kirtane, Ke Xu, Ran Kornowski, Sorin J. Brener, Philippe Généreux, Gregg W. Stone, Roxana Mehran

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150 Scopus citations

Abstract

Background - Contrast-induced acute kidney injury (CI-AKI), defined as a serum creatinine increase ≥0.5 mg/dL or ≥25% within 72 hours after contrast exposure, is a common complication of procedures requiring contrast media and is associated with increased short- and long-term morbidity and mortality. Few studies describe the effects of CI-AKI in a large-scale acute coronary syndrome population, and the relationship between CI-AKI and bleeding events has not been extensively explored. We sought to evaluate the impact of CI-AKI after percutaneous coronary intervention in patients presenting with acute coronary syndrome. Methods and Results - We pooled patient-level data for 9512 patients from the percutaneous coronary intervention cohorts of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) and Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) multicenter randomized trials. Patients were classified according to CI-AKI development, and cardiovascular outcomes at 30 days and 1 year were compared between groups. A total of 1212 patients (12.7%) developed CI-AKI. Patients with CI-AKI were older, with a more extensive comorbidity profile than without CI-AKI. Multivariable analysis confirmed several previously identified predictors of CI-AKI, including diabetes mellitus, contrast volume, age, and baseline hemoglobin. Mortality rates were significantly higher in the CI-AKI group at 30 days (4.9% versus 0.7%; P<0.0001) and 1 year (9.8% versus 2.9%; P<0.0001), as were rates of 1-year myocardial infarction, definite/probable stent thrombosis, target lesion revascularization, and major adverse cardiac events. Major bleeding (13.8% versus 5.4%; hazard ratio, 2.64; 95% confidence interval, 2.21-3.15; P<0.0001) was also higher in patients with CI-AKI. After multivariable adjustment, results were unchanged. Conclusions - CI-AKI after percutaneous coronary intervention in patients presenting with acute coronary syndrome is independently associated with increased risk of short- and long-term ischemic and hemorrhagic events.

Original languageEnglish
Article numbere002475
JournalCirculation: Cardiovascular Interventions
Volume8
Issue number8
DOIs
StatePublished - 1 Aug 2015

Keywords

  • angioplasty
  • contrast media
  • diabetes mellitus
  • kidney
  • thrombosis

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