Association of contrast-induced acute kidney injury with long-term cardiovascular events in acute coronary syndrome patients with chronic kidney disease undergoing emergent percutaneous coronary intervention

• Published in: International journal of cardiology Vol. 174; no. 1; pp. 57 - 63
• Main Authors: Watabe, Hiroaki, Sato, Akira, Hoshi, Tomoya, Takeyasu, Noriyuki, Abe, Daisuke, Akiyama, Daiki, Kakefuda, Yuki, Nishina, Hidetaka, Noguchi, Yuichi, Aonuma, Kazutaka
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.06.2014; Elsevier
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - complications; Acute Kidney Injury - chemically induced; Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cardiovascular Diseases - complications; Chronic kidney disease; Cohort Studies; Contrast Media - adverse effects; Contrast-induced acute kidney injury; Coronary heart disease; Diseases of the cardiovascular system; Emergency Treatment; Female; Heart; Humans; Kidneys; Male; Medical sciences; Myocarditis. Cardiomyopathies; Nephrology. Urinary tract diseases; Percutaneous Coronary Intervention; Prognosis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Renal Insufficiency, Chronic - complications; Retrospective Studies; Time Factors; Urinary system involvement in other diseases. Miscellaneous; Contrast-induced acute kidney injury; Chronic kidney disease; Percutaneous coronary intervention; Prognosis; Acute coronary syndrome; Angioplasty; Toxicity; Cardiovascular disease; Myocardial disease; Stent; Percutaneous route; Association; Radioopaque marker; Cardiology; Contrast media; Kidney disease; Human; Atherectomy; Urinary system disease; Acute kidney injury; Coronary artery; Instrumentation therapy; Patient; Coronary heart disease; Long term; Renal failure
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2014.03.146

Abstract Background The association between contrast-induced acute kidney injury (CI-AKI) and chronic kidney disease (CKD) in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) has not been fully reported. We evaluated the association of CI-AKI on cardiovascular events in ACS patients with CKD. Methods A total of 1059 ACS patients who underwent emergent PCI in our multicenter registry were enrolled (69 ± 12 years, 804 men, 604 STEMI patients). CKD was defined as at least stage 3 CKD, and CI-AKI was defined as an increase of at least 0.5 mg/dL and/or an increase of at least 25% of pre-PCI to post-PCI serum creatinine levels within 1 week after the procedure. Primary endpoints included cardiovascular death, myocardial infarction, and cerebrovascular disorder (stroke or transient ischemic attack). Results In our study, 368 (34.7%) patients had CKD. During follow-up periods (435 ± 330 days), CI-AKI and primary endpoints occurred in 164 (15.5%) patients and 106 (10.0%) patients, respectively. Multivariate Cox proportional hazards model revealed that age, female gender, peak creatinine kinase > 4000, IABP use, CI-AKI (hazard ratio [HR], 2.17; 95% confidential interval [CI], 1.52 to 4.00; P < 0.001), and CKD (HR, 1.66; 95% CI, 1.01 to 2.72; P = 0.046) were independent predictors of primary endpoints. Kaplan–Meier analysis showed that occurrence of primary endpoints increased significantly with an increase in CKD stage, and CI-AKI yielded worse long-term prognosis at every stage of CKD ( P < 0.001). Conclusions CI-AKI was revealed to be a significant incremental predictor of cardiovascular events at each stage of CKD in ACS patients.