Validation of a Contemporary Acute Kidney Injury Risk Score in Patients With Acute Coronary Syndrome

Antonio Landi, Mauro Chiarito, Mattia Branca, Enrico Frigoli, Andrea Gagnor, Paolo Calabrò, Carlo Briguori, Giuseppe Andò, Alessandra Repetto, Ugo Limbruno, Paolo Sganzerla, Alessandro Lupi, Bernardo Cortese, Arturo Ausiello, Salvatore Ierna, Giovanni Esposito, Giuseppe Ferrante, Andrea Santarelli, Gennaro Sardella, Ferdinando VarbellaDik Heg, Roxana Mehran, Marco Valgimigli

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: A simple, contemporary risk score for the prediction of contrast-associated acute kidney injury (CA-AKI) after percutaneous coronary intervention (PCI) was recently updated, although its external validation is lacking. Objectives: The aim of this study was to validate the updated CA-AKI risk score in a large cohort of acute coronary syndrome patients from the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of angioX) trial. Methods: The risk score identifies 4 risk categories for CA-AKI. The primary endpoint was to appraise the receiver-operating characteristics of an 8-component and a 12-component CA-AKI model. Independent predictors of Kidney Disease Improving Global Outcomes–based acute kidney injury and the impact of CA-AKI on 1-year mortality and bleeding were also investigated. Results: The MATRIX trial included 8,201 patients with complete creatinine values and no end-stage renal disease. CA-AKI occurred in 5.5% of the patients, with a stepwise increase of CA-AKI rates from the lowest to the highest of the 4 risk categories. The receiver-operating characteristic area under the curve was 0.67 (95% CI: 0.64-0.70) with model 1 and 0.71 (95% CI: 0.68-0.74) with model 2. CA-AKI risk was systematically overestimated with both models (Hosmer-Lemeshow goodness-of-fit test: P < 0.05). The 1-year risks of all-cause mortality and bleeding were higher in CA-AKI patients (HR: 7.03 [95% CI: 5.47-9.05] and HR: 3.20 [95% CI: 2.56-3.99]; respectively). There was a gradual risk increase for mortality and bleeding as a function of the CA-AKI risk category for both models. Conclusions: The updated CA-AKI risk score identifies patients at incremental risks of acute kidney injury, bleeding, and mortality.

Original languageEnglish
Pages (from-to)1873-1886
Number of pages14
JournalJACC: Cardiovascular Interventions
Volume16
Issue number15
DOIs
StatePublished - 14 Aug 2023

Keywords

  • acute coronary syndrome
  • acute kidney injury
  • percutaneous coronary intervention
  • risk score

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