Kelvin C W Leung1, Neesh Pannu2, Zhi Tan3, William A Ghali4, Merril L Knudtson1, Brenda R Hemmelgarn4, Marcello Tonelli1, Matthew T James5. 1. Departments of Medicine and. 2. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 3. Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; and. 4. Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; and. 5. Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; and mjames@ucalgary.ca.
Abstract
BACKGROUND AND OBJECTIVES: AKI after coronary angiography is associated with poor long-term outcomes. The relationship between contrast-associated AKI and subsequent use of prognosis-modifying cardiovascular medications is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A cohort study of 5911 participants 66 years of age or older with acute coronary syndrome who received a coronary angiogram in Alberta, Canada was performed between November 1, 2002, and November 30, 2008. AKI was identified according to Kidney Disease Improving Global Outcomes AKI criteria. RESULTS: In multivariable logistic regression models, compared with participants without AKI, those with stages 1 and 2-3 AKI had lower odds of subsequent use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker within 120 days of hospital discharge (adjusted odds ratio, 0.65; 95% confidence interval, 0.53 to 0.80 and odds ratio, 0.34; 95% confidence interval, 0.23 to 0.48, respectively). Subsequent statin and β-blockers use within 120 days of hospital discharge was significantly lower among those with stages 2-3 AKI (adjusted odds ratio, 0.44; 95% confidence interval, 0.31 to 0.64 and odds ratio, 0.46; 95% confidence interval, 0.31 to 0.66, respectively). These associations were consistently seen in patients with diabetes mellitus, heart failure, low baseline eGFR, and albuminuria; 952 participants died during subsequent follow-up after hospital discharge (mean=3.1 years). The use of each class of cardiovascular medication was associated with lower mortality, including among those who had experienced AKI. CONCLUSIONS: Strategies to optimize the use of cardiac medications in people with AKI after coronary angiography might improve care.
BACKGROUND AND OBJECTIVES: AKI after coronary angiography is associated with poor long-term outcomes. The relationship between contrast-associated AKI and subsequent use of prognosis-modifying cardiovascular medications is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A cohort study of 5911 participants 66 years of age or older with acute coronary syndrome who received a coronary angiogram in Alberta, Canada was performed between November 1, 2002, and November 30, 2008. AKI was identified according to Kidney Disease Improving Global Outcomes AKI criteria. RESULTS: In multivariable logistic regression models, compared with participants without AKI, those with stages 1 and 2-3 AKI had lower odds of subsequent use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker within 120 days of hospital discharge (adjusted odds ratio, 0.65; 95% confidence interval, 0.53 to 0.80 and odds ratio, 0.34; 95% confidence interval, 0.23 to 0.48, respectively). Subsequent statin and β-blockers use within 120 days of hospital discharge was significantly lower among those with stages 2-3 AKI (adjusted odds ratio, 0.44; 95% confidence interval, 0.31 to 0.64 and odds ratio, 0.46; 95% confidence interval, 0.31 to 0.66, respectively). These associations were consistently seen in patients with diabetes mellitus, heart failure, low baseline eGFR, and albuminuria; 952 participants died during subsequent follow-up after hospital discharge (mean=3.1 years). The use of each class of cardiovascular medication was associated with lower mortality, including among those who had experienced AKI. CONCLUSIONS: Strategies to optimize the use of cardiac medications in people with AKI after coronary angiography might improve care.
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