Long-Term Clinical Impact of Contrast-Associated Acute Kidney Injury Following PCI: An ADAPT-DES Substudy

Reza Mohebi, Keyvan Karimi Galougahi, Javier Jas Garcia, Jennifer Horst, Ori Ben-Yehuda, Jai Radhakrishnan, Glenn M. Chertow, Allen Jeremias, David J. Cohen, Akiko Maehara, Gary S. Mintz, Shmuel Chen, Björn Redfors, Martin B. Leon, Thomas D. Stuckey, Michael J. Rinaldi, Giora Weisz, Bernhard Witzenbichler, Ajay J. Kirtane, Roxana MehranGeorge D. Dangas, Gregg W. Stone, Ziad A. Ali

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Objectives: This study sought to determine correlates and consequences of contrast-associated acute kidney injury (CA-AKI) on clinical outcomes in patients with or without pre-existing chronic kidney disease (CKD). Background: The incidence and impact of CA-AKI on clinical outcomes during contemporary percutaneous coronary intervention (PCI) are not fully defined. Methods: The ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents) study was a prospective, multicenter registry of 8,582 patients treated with ≥1 drug-eluting stent(s). CA-AKI was defined as a post-PCI increase in serum creatinine of >0.5 mg/dL or a relative increase of ≥25% compared with pre-PCI. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2. The primary endpoint was the 2-year rate of net adverse clinical events (NACE): All-cause mortality, myocardial infarction (MI), definite or probable stent thrombosis, or major bleeding. Results: Of 7287 (85%) patients with evaluable data, 476 (6.5%) developed CA-AKI. In a multivariable model, older age, female sex, Caucasian race, congestive heart failure, diabetes, hypertension, CKD, presentation with ST-segment elevation MI, Killip class II to IV, radial access, intra-aortic balloon pump use, hypotension, and number of stents were independent predictors of CA-AKI. The 2-year NACE rate was higher in patients with CA-AKI (adjusted HR: 1.88; 95% CI: 1.42-2.49), as was each component of NACE (all-cause mortality, HR: 1.77; 95% CI: 1.22-2.55; MI, HR: 1.67; 95% CI: 1.18-2.36; definite/probable stent thrombosis, HR: 1.71; 95% CI: 1.10-2.65; and major bleeding, HR: 1.38; 95% CI: 1.06-1.80). Compared with the CA-AKI–/CKD– group, the CA-AKI+/CKD– (HR: 1.83; 95% CI: 1.33-2.52), CA-AKI–/CKD+ (HR: 1.56; 95% CI: 1.15-2.13), CA-AKI+/CKD+ (HR: 3.29; 95% CI: 1.92-5.67), and maintenance dialysis (HR: 2.67; 95% CI: 1.65-4.31) groups were at higher risk of NACE. Conclusions: CA-AKI was relatively common after contemporary PCI and was associated with increased 2-year rates of NACE. Patients with pre-existing CKD were at particularly high risk for NACE after CA-AKI.

Original languageEnglish
Pages (from-to)753-766
Number of pages14
JournalJACC: Cardiovascular Interventions
Volume15
Issue number7
DOIs
StatePublished - 11 Apr 2022

Keywords

  • chronic kidney disease
  • contrast-associated nephropathy
  • percutaneous coronary intervention

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