TY - JOUR
T1 - Risk of contrast-induced acute kidney injury in ST-elevation myocardial infarction patients undergoing multi-vessel intervention-meta-analysis of randomized trials and risk prediction modeling study using observational data
AU - Chatterjee, Saurav
AU - Kundu, Amartya
AU - Mukherjee, Debabrata
AU - Sardar, Partha
AU - Mehran, Roxana
AU - Bashir, Riyaz
AU - Giri, Jay
AU - Abbott, Jinnette D.
N1 - Publisher Copyright:
© 2017 Wiley Periodicals, Inc.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Objectives: Ascertaining risk of contrast induced acute kidney injury (CI-AKI) in ST-segment elevation myocardial infarction (STEMI) patients undergoing multi-vessel percutaneous coronary intervention (MV-PCI). Background: Complete revascularization may improve outcomes in STEMI patients with multi-vessel disease. However, a practice of MV-PCI may be associated with a higher risk of CI-AKI. We aimed to evaluate the risk of CI-AKI in patients with STEMI and MV-PCI and examine the accuracy of a validated risk score. Methods: We searched PubMed, Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from inception through August 31, 2016 for randomized studies comparing CI-AKI rates with MV-PCI and infarct-related artery (IRA) only PCI during index hospitalization. A random effects model was used to estimate the risk ratio (RR) and respective 95% confidence intervals (CI). We queried the Nationwide Inpatient Sample (NIS) to assess the ability of the Mehran risk score to accurately predict the incidence of CI-AKI in patients undergoing MV-PCI. Results: Four randomized studies (N = 1,602) were included in the final analysis. The risk of CI-AKI was low and no difference was observed with MV-PCI (1.45%) compared with IRA-only (1.94%) (RR 0.73, 95% CI 0.34-1.57; P = 0.57). From 2009 to 2012, excluding shock, there were 11,454 MV-PCI for STEMI patients in the NIS. The Mehran risk score accurately discriminated 78% of the patients who developed CI-AKI in this cohort (c-statistic of 0.78, P = 0.002). Conclusions: MV-PCI in STEMI is not associated with a higher risk of CI-AKI and the Mehran risk score can identify patients at higher risk for this complication.
AB - Objectives: Ascertaining risk of contrast induced acute kidney injury (CI-AKI) in ST-segment elevation myocardial infarction (STEMI) patients undergoing multi-vessel percutaneous coronary intervention (MV-PCI). Background: Complete revascularization may improve outcomes in STEMI patients with multi-vessel disease. However, a practice of MV-PCI may be associated with a higher risk of CI-AKI. We aimed to evaluate the risk of CI-AKI in patients with STEMI and MV-PCI and examine the accuracy of a validated risk score. Methods: We searched PubMed, Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from inception through August 31, 2016 for randomized studies comparing CI-AKI rates with MV-PCI and infarct-related artery (IRA) only PCI during index hospitalization. A random effects model was used to estimate the risk ratio (RR) and respective 95% confidence intervals (CI). We queried the Nationwide Inpatient Sample (NIS) to assess the ability of the Mehran risk score to accurately predict the incidence of CI-AKI in patients undergoing MV-PCI. Results: Four randomized studies (N = 1,602) were included in the final analysis. The risk of CI-AKI was low and no difference was observed with MV-PCI (1.45%) compared with IRA-only (1.94%) (RR 0.73, 95% CI 0.34-1.57; P = 0.57). From 2009 to 2012, excluding shock, there were 11,454 MV-PCI for STEMI patients in the NIS. The Mehran risk score accurately discriminated 78% of the patients who developed CI-AKI in this cohort (c-statistic of 0.78, P = 0.002). Conclusions: MV-PCI in STEMI is not associated with a higher risk of CI-AKI and the Mehran risk score can identify patients at higher risk for this complication.
KW - STEMI
KW - contrast-induced acute kidney injury
KW - mehran risk score
KW - multivessel-PCI
UR - http://www.scopus.com/inward/record.url?scp=85010304603&partnerID=8YFLogxK
U2 - 10.1002/ccd.26928
DO - 10.1002/ccd.26928
M3 - Article
C2 - 28112470
AN - SCOPUS:85010304603
SN - 1522-1946
VL - 90
SP - 205
EP - 212
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 2
ER -