Amar Narula1, Roxana Mehran2, Giora Weisz3, George D Dangas4, Jennifer Yu5, Philippe Généreux6, Eugenia Nikolsky7, Sorin J Brener8, Bernhard Witzenbichler9, Giulio Guagliumi10, Avery E Clark11, Martin Fahy12, Ke Xu12, Bruce R Brodie13, Gregg W Stone14. 1. NYU Langone Medical Center, New York, NY, USA. 2. Icahn School of Medicine at Mount Sinai, New York, NY, USA Cardiovascular Research Foundation, New York, NY, USA roxana.mehran@mountsinai.org. 3. Cardiovascular Research Foundation, New York, NY, USA Columbia University Medical Center, New York, NY, USA Shaare Zedek Medical Center, Jerusalem, Israel. 4. Icahn School of Medicine at Mount Sinai, New York, NY, USA Cardiovascular Research Foundation, New York, NY, USA. 5. Icahn School of Medicine at Mount Sinai, New York, NY, USA. 6. Cardiovascular Research Foundation, New York, NY, USA Columbia University Medical Center, New York, NY, USA Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada. 7. Rambam Health Care Campus and the Technion - Israel Institute of Technology, Haifa, Israel. 8. Cardiovascular Research Foundation, New York, NY, USA New York Methodist Hospital, Brooklyn, NY, USA. 9. Amper Kliniken AG, Dachau, Germany. 10. Ospedale Papa Giovanni XXIII, Bergamo, Italy. 11. The Warren Alpert Medical School of Brown University, Providence, RI, USA. 12. Cardiovascular Research Foundation, New York, NY, USA. 13. LeBauer Cardiovascular Research Foundation and Moses Cone Heart and Vascular Center, Greensboro, NC, USA. 14. Cardiovascular Research Foundation, New York, NY, USA Columbia University Medical Center, New York, NY, USA.
Abstract
AIM: We sought to examine the short- and long-term outcomes of patients who developed contrast-induced acute kidney injury (CI-AKI; defined as an increase in serum creatinine of ≥0.5 mg/dL or a 25% relative rise within 48 h after contrast exposure) from the large-scale HORIZONS-AMI trial. METHODS AND RESULTS: Multivariable analyses were used to identify predictors of CI-AKI, as well predictors of the primary and secondary endpoints. The incidence of CI-AKI in this cohort of ST-segment elevation myocardial infarction (STEMI) patients was 16.1% (479/2968). Predictors of CI-AKI were contrast volume, white blood cell count, left anterior descending infarct-related artery, age, anaemia, creatinine clearance <60 mL/min, and history of congestive heart failure. Patients with CI-AKI had higher rates of net adverse clinical events [NACE; a combination of major bleeding or composite major adverse cardiac events (MACE; consisting of death, reinfarction, target vessel revascularization for ischaemia, or stroke)] at 30 days (22.0 vs. 9.3%; P < 0.0001) and 3 years (40.3 vs. 24.6%; P < 0.0001). They also had higher rates of mortality at 30 days (8.0 vs. 0.9%; P < 0.0001) and 3 years (16.2 vs. 4.5%; P < 0.0001). Multivariable analysis confirmed CI-AKI as an independent predictor of NACE [hazard ratio ([HR), 1.53; 95% confidence interval (CI), 1.23-1.90; P = 0.0001], MACE (HR, 1.56; 95% CI, 1.23-1.98; P = 0.0002), non-coronary artery bypass grafting major bleeding (HR, 2.07; 95% CI, 1.57-2.73; P < 0.0001), and mortality (HR, 1.80; 95% CI, 1.19-2.73; P = 0.005) at 3-year follow-up. CONCLUSION: Contrast-induced acute kidney injury is associated with poor short- and long-term outcomes after primary percutaneous coronary intervention in STEMI. Published on behalf of the European Society of Cardiology. All rights reserved.
RCT Entities:
AIM: We sought to examine the short- and long-term outcomes of patients who developed contrast-induced acute kidney injury (CI-AKI; defined as an increase in serum creatinine of ≥0.5 mg/dL or a 25% relative rise within 48 h after contrast exposure) from the large-scale HORIZONS-AMI trial. METHODS AND RESULTS: Multivariable analyses were used to identify predictors of CI-AKI, as well predictors of the primary and secondary endpoints. The incidence of CI-AKI in this cohort of ST-segment elevation myocardial infarction (STEMI) patients was 16.1% (479/2968). Predictors of CI-AKI were contrast volume, white blood cell count, left anterior descending infarct-related artery, age, anaemia, creatinine clearance <60 mL/min, and history of congestive heart failure. Patients with CI-AKI had higher rates of net adverse clinical events [NACE; a combination of major bleeding or composite major adverse cardiac events (MACE; consisting of death, reinfarction, target vessel revascularization for ischaemia, or stroke)] at 30 days (22.0 vs. 9.3%; P < 0.0001) and 3 years (40.3 vs. 24.6%; P < 0.0001). They also had higher rates of mortality at 30 days (8.0 vs. 0.9%; P < 0.0001) and 3 years (16.2 vs. 4.5%; P < 0.0001). Multivariable analysis confirmed CI-AKI as an independent predictor of NACE [hazard ratio ([HR), 1.53; 95% confidence interval (CI), 1.23-1.90; P = 0.0001], MACE (HR, 1.56; 95% CI, 1.23-1.98; P = 0.0002), non-coronary artery bypass grafting major bleeding (HR, 2.07; 95% CI, 1.57-2.73; P < 0.0001), and mortality (HR, 1.80; 95% CI, 1.19-2.73; P = 0.005) at 3-year follow-up. CONCLUSION: Contrast-induced acute kidney injury is associated with poor short- and long-term outcomes after primary percutaneous coronary intervention in STEMI. Published on behalf of the European Society of Cardiology. All rights reserved.