Judith Kooiman1, Milan Seth1, Brahmajee K Nallamothu1, Michael Heung1, David Humes1, Hitinder S Gurm2. 1. From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.). 2. From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.). hgurm@med.umich.edu.
Abstract
BACKGROUND: Acute kidney injury (AKI) post percutaneous coronary intervention (PCI) is associated with increased mortality but both death and AKI share common risk factors. Moreover, the effect of a high contrast dose, a known modifiable risk factor for AKI, on mortality is unknown. The aim of our study was to analyze the association between AKI and in-hospital mortality post PCI after adjustment for confounding by common risk factors. METHODS AND RESULTS: This study was performed using a regional registry of all patients undergoing PCI in Michigan. Primary end points were AKI (serum creatinine increase >0.5 mg/dL) and all-cause in-hospital mortality. Propensity matching was performed, with each AKI patient matched to 4 controls. Attributable risk fraction and the exposed index number of AKI for mortality were calculated within the propensity-matched cohort. Between 2010 and 2013, 92 317 patients underwent PCI, of whom 2141 (2.3%) developed AKI. We matched 1371/2141 patients with AKI to 5484 controls. AKI was strongly associated with mortality (odds ratio=12.52, 95% confidence interval 9.29-16.86) in the propensity-matched cohort. The attributable risk fraction for mortality of AKI was 31.4% (95% confidence interval 26.8%-37.5%), and one death could be prevented for every 9 cases of AKI successfully avoided. The independent impact of a high contrast dose at time of PCI on in-hospital mortality risk was weak (adjusted odds ratio 1.19, 95% confidence interval 0.97-1.45). CONCLUSIONS: Nearly one-third of the in-hospital mortality post PCI is attributable to AKI. Preventing 9 cases of AKI could potentially prevent one death. These study findings stress the need for developing effective AKI preventive strategies beyond minimization of contrast dose.
BACKGROUND:Acute kidney injury (AKI) post percutaneous coronary intervention (PCI) is associated with increased mortality but both death and AKI share common risk factors. Moreover, the effect of a high contrast dose, a known modifiable risk factor for AKI, on mortality is unknown. The aim of our study was to analyze the association between AKI and in-hospital mortality post PCI after adjustment for confounding by common risk factors. METHODS AND RESULTS: This study was performed using a regional registry of all patients undergoing PCI in Michigan. Primary end points were AKI (serum creatinine increase >0.5 mg/dL) and all-cause in-hospital mortality. Propensity matching was performed, with each AKI patient matched to 4 controls. Attributable risk fraction and the exposed index number of AKI for mortality were calculated within the propensity-matched cohort. Between 2010 and 2013, 92 317 patients underwent PCI, of whom 2141 (2.3%) developed AKI. We matched 1371/2141 patients with AKI to 5484 controls. AKI was strongly associated with mortality (odds ratio=12.52, 95% confidence interval 9.29-16.86) in the propensity-matched cohort. The attributable risk fraction for mortality of AKI was 31.4% (95% confidence interval 26.8%-37.5%), and one death could be prevented for every 9 cases of AKI successfully avoided. The independent impact of a high contrast dose at time of PCI on in-hospital mortality risk was weak (adjusted odds ratio 1.19, 95% confidence interval 0.97-1.45). CONCLUSIONS: Nearly one-third of the in-hospital mortality post PCI is attributable to AKI. Preventing 9 cases of AKI could potentially prevent one death. These study findings stress the need for developing effective AKI preventive strategies beyond minimization of contrast dose.
Authors: Sang Gune K Yoo; Milan Seth; Muthiah Vaduganathan; Cyril Ruwende; Milind Karve; Ibrahim Shah; Thomas Hill; Hitinder S Gurm; Devraj Sukul Journal: JACC Cardiovasc Interv Date: 2021-08-23 Impact factor: 11.195
Authors: Aart J van der Molen; Peter Reimer; Ilona A Dekkers; Georg Bongartz; Marie-France Bellin; Michele Bertolotto; Olivier Clement; Gertraud Heinz-Peer; Fulvio Stacul; Judith A W Webb; Henrik S Thomsen Journal: Eur Radiol Date: 2018-02-09 Impact factor: 5.315