Yohei Ohno1, Yuichiro Maekawa1, Hiroaki Miyata2, Soushin Inoue3, Shiro Ishikawa4, Koichiro Sueyoshi5, Shigetaka Noma6, Akio Kawamura1, Shun Kohsaka7, Keiichi Fukuda1. 1. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. 2. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 3. Department of Cardiology, Hino Municipal Hospital, Tokyo, Japan. 4. Department of Cardiology, Saitama Municipal Hospital, Saitama, Japan. 5. Department of Cardiology, Kawasaki Municipal Hospital, Kanagawa, Japan. 6. Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan. 7. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. Electronic address: kohsaka@cpnet.med.keio.ac.jp.
Abstract
OBJECTIVES: This study sought to evaluate the association between contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention and severity of bleeding estimated from periprocedural hemoglobin (Hb) measurement. BACKGROUND: The relationship between CI-AKI and bleeding in contemporary practice remains controversial. METHODS: In a retrospective analysis of the prospectively maintained Japan Cardiovascular Database-Keio Interhospital Cardiovascular Studies (JCD-KICS) multicenter registry, we divided 2,646 consecutive patients into 5 groups according to the change of Hb level after compared with before percutaneous coronary intervention: patients without a decrease in Hb level (group A) and patients with a decreased Hb level: <1 g/dl (group B); 1 to <2 g/dl (group C); 2 to <3g/dl (group D); and >3 g/dl (group E). CI-AKI was defined as an increase in serum creatinine level ≥ 0.5 mg/dl or ≥ 25% above baseline values at 48 h after administration of contrast media. Procedure and outcome variables were compared. RESULTS: The mean patient age was 67 ± 11 years. Of the 2,646 patients, CI-AKI developed in 315 (11.9%). The CI-AKI incidence was 6.2%, 7.5%, 10.7%, 17.0%, and 26.2%, in groups A through E, respectively (p < 0.01), whereas the incidence of major bleeding was 0.7%, 1.3%, 2.0%, 4.1%, and 28.3%, respectively (p < 0.01). CI-AKI was associated with higher rates of mortality (5.4% vs. 0.6%, p < 0.01) and of composite of heart failure, cardiogenic shock, and death (16.5% vs. 2.8%, p < 0.01). CONCLUSIONS: Periprocedural bleeding was significantly associated with CI-AKI, with CI-AKI incidence correlating with bleeding severity.
OBJECTIVES: This study sought to evaluate the association between contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention and severity of bleeding estimated from periprocedural hemoglobin (Hb) measurement. BACKGROUND: The relationship between CI-AKI and bleeding in contemporary practice remains controversial. METHODS: In a retrospective analysis of the prospectively maintained Japan Cardiovascular Database-Keio Interhospital Cardiovascular Studies (JCD-KICS) multicenter registry, we divided 2,646 consecutive patients into 5 groups according to the change of Hb level after compared with before percutaneous coronary intervention: patients without a decrease in Hb level (group A) and patients with a decreased Hb level: <1 g/dl (group B); 1 to <2 g/dl (group C); 2 to <3g/dl (group D); and >3 g/dl (group E). CI-AKI was defined as an increase in serum creatinine level ≥ 0.5 mg/dl or ≥ 25% above baseline values at 48 h after administration of contrast media. Procedure and outcome variables were compared. RESULTS: The mean patient age was 67 ± 11 years. Of the 2,646 patients, CI-AKI developed in 315 (11.9%). The CI-AKI incidence was 6.2%, 7.5%, 10.7%, 17.0%, and 26.2%, in groups A through E, respectively (p < 0.01), whereas the incidence of major bleeding was 0.7%, 1.3%, 2.0%, 4.1%, and 28.3%, respectively (p < 0.01). CI-AKI was associated with higher rates of mortality (5.4% vs. 0.6%, p < 0.01) and of composite of heart failure, cardiogenic shock, and death (16.5% vs. 2.8%, p < 0.01). CONCLUSIONS: Periprocedural bleeding was significantly associated with CI-AKI, with CI-AKI incidence correlating with bleeding severity.
Authors: Bhaskar Bhardwaj; John A Spertus; Kevin F Kennedy; W Schuyler Jones; David Safley; Thomas T Tsai; Herbert D Aronow; Amit N Vora; Yashashwi Pokharel; Arun Kumar; Robert R Attaran; Dmitriy N Feldman; Ehrin Armstrong; Anand Prasad; Bruce Gray; Adam C Salisbury Journal: JACC Cardiovasc Interv Date: 2019-06-24 Impact factor: 11.195