Daniele Giacoppo1, Mahesh V Madhavan1, Usman Baber1, Josephine Warren1, Sameer Bansilal1, Bernhard Witzenbichler1, George D Dangas1, Ajay J Kirtane1, Ke Xu1, Ran Kornowski1, Sorin J Brener1, Philippe Généreux1, Gregg W Stone1, Roxana Mehran2. 1. From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.). 2. From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.). rmehran@crf.org.
Abstract
BACKGROUND: Contrast-induced acute kidney injury (CI-AKI), defined as a serum creatinine increase ≥0.5 mg/dL or ≥25% within 72 hours after contrast exposure, is a common complication of procedures requiring contrast media and is associated with increased short- and long-term morbidity and mortality. Few studies describe the effects of CI-AKI in a large-scale acute coronary syndrome population, and the relationship between CI-AKI and bleeding events has not been extensively explored. We sought to evaluate the impact of CI-AKI after percutaneous coronary intervention in patients presenting with acute coronary syndrome. METHODS AND RESULTS: We pooled patient-level data for 9512 patients from the percutaneous coronary intervention cohorts of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) and Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) multicenter randomized trials. Patients were classified according to CI-AKI development, and cardiovascular outcomes at 30 days and 1 year were compared between groups. A total of 1212 patients (12.7%) developed CI-AKI. Patients with CI-AKI were older, with a more extensive comorbidity profile than without CI-AKI. Multivariable analysis confirmed several previously identified predictors of CI-AKI, including diabetes mellitus, contrast volume, age, and baseline hemoglobin. Mortality rates were significantly higher in the CI-AKI group at 30 days (4.9% versus 0.7%; P<0.0001) and 1 year (9.8% versus 2.9%; P<0.0001), as were rates of 1-year myocardial infarction, definite/probable stent thrombosis, target lesion revascularization, and major adverse cardiac events. Major bleeding (13.8% versus 5.4%; hazard ratio, 2.64; 95% confidence interval, 2.21-3.15; P<0.0001) was also higher in patients with CI-AKI. After multivariable adjustment, results were unchanged. CONCLUSIONS: CI-AKI after percutaneous coronary intervention in patients presenting with acute coronary syndrome is independently associated with increased risk of short- and long-term ischemic and hemorrhagic events. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00433966 (HORIZONS-AMI) and ACUITY (NCT00093158).
BACKGROUND: Contrast-induced acute kidney injury (CI-AKI), defined as a serum creatinine increase ≥0.5 mg/dL or ≥25% within 72 hours after contrast exposure, is a common complication of procedures requiring contrast media and is associated with increased short- and long-term morbidity and mortality. Few studies describe the effects of CI-AKI in a large-scale acute coronary syndrome population, and the relationship between CI-AKI and bleeding events has not been extensively explored. We sought to evaluate the impact of CI-AKI after percutaneous coronary intervention in patients presenting with acute coronary syndrome. METHODS AND RESULTS: We pooled patient-level data for 9512 patients from the percutaneous coronary intervention cohorts of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) and Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) multicenter randomized trials. Patients were classified according to CI-AKI development, and cardiovascular outcomes at 30 days and 1 year were compared between groups. A total of 1212 patients (12.7%) developed CI-AKI. Patients with CI-AKI were older, with a more extensive comorbidity profile than without CI-AKI. Multivariable analysis confirmed several previously identified predictors of CI-AKI, including diabetes mellitus, contrast volume, age, and baseline hemoglobin. Mortality rates were significantly higher in the CI-AKI group at 30 days (4.9% versus 0.7%; P<0.0001) and 1 year (9.8% versus 2.9%; P<0.0001), as were rates of 1-year myocardial infarction, definite/probable stent thrombosis, target lesion revascularization, and major adverse cardiac events. Major bleeding (13.8% versus 5.4%; hazard ratio, 2.64; 95% confidence interval, 2.21-3.15; P<0.0001) was also higher in patients with CI-AKI. After multivariable adjustment, results were unchanged. CONCLUSIONS: CI-AKI after percutaneous coronary intervention in patients presenting with acute coronary syndrome is independently associated with increased risk of short- and long-term ischemic and hemorrhagic events. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00433966 (HORIZONS-AMI) and ACUITY (NCT00093158).
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