Long-Term Clinical Impact of Contrast-Associated Acute Kidney Injury Following PCI: An ADAPT-DES Substudy.

Abstract

OBJECTIVES:

This study sought to determine correlates and consequences of contrast-associated acute kidney injury (CA-AKI) on clinical outcomes in patients with or without pre-existing chronic kidney disease (CKD).

BACKGROUND:

The incidence and impact of CA-AKI on clinical outcomes during contemporary percutaneous coronary intervention (PCI) are not fully defined.

METHODS:

The ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents) study was a prospective, multicenter registry of 8,582 patients treated with ≥1 drug-eluting stent(s). CA-AKI was defined as a post-PCI increase in serum creatinine of >0.5 mg/dL or a relative increase of ≥25% compared with pre-PCI. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2. The primary endpoint was the 2-year rate of net adverse clinical events (NACE): All-cause mortality, myocardial infarction (MI), definite or probable stent thrombosis, or major bleeding.

RESULTS:

Of 7287 (85%) patients with evaluable data, 476 (6.5%) developed CA-AKI. In a multivariable model, older age, female sex, Caucasian race, congestive heart failure, diabetes, hypertension, CKD, presentation with ST-segment elevation MI, Killip class II to IV, radial access, intra-aortic balloon pump use, hypotension, and number of stents were independent predictors of CA-AKI. The 2-year NACE rate was higher in patients with CA-AKI (adjusted HR: 1.88; 95% CI: 1.42-2.49), as was each component of NACE (all-cause mortality, HR: 1.77; 95% CI: 1.22-2.55; MI, HR: 1.67; 95% CI: 1.18-2.36; definite/probable stent thrombosis, HR: 1.71; 95% CI: 1.10-2.65; and major bleeding, HR: 1.38; 95% CI: 1.06-1.80). Compared with the CA-AKI-/CKD- group, the CA-AKI+/CKD- (HR: 1.83; 95% CI: 1.33-2.52), CA-AKI-/CKD+ (HR: 1.56; 95% CI: 1.15-2.13), CA-AKI+/CKD+ (HR: 3.29; 95% CI: 1.92-5.67), and maintenance dialysis (HR: 2.67; 95% CI: 1.65-4.31) groups were at higher risk of NACE.

CONCLUSIONS:

CA-AKI was relatively common after contemporary PCI and was associated with increased 2-year rates of NACE. Patients with pre-existing CKD were at particularly high risk for NACE after CA-AKI.

• Authors: Reza Mohebi, Keyvan Karimi Galougahi, Javier Jas Garcia, Jennifer Horst, Ori Ben-Yehuda, Jai Radhakrishnan, Glenn M Chertow, Allen Jeremias, David J Cohen, David J Cohen, Akiko Maehara, Gary S Mintz, Shmuel Chen, Björn Redfors, Martin B Leon, Thomas D Stuckey, Michael J Rinaldi, Giora Weisz, Bernhard Witzenbichler, Ajay J Kirtane, Roxana Mehran, George D Dangas, Gregg W Stone, Ziad A Ali
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 15 Issue 7 Pg. 753-766 (04 11 2022) ISSN: 1876-7605 [Electronic] United States
• PMID: 35305904 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Contrast Media

Topics

• Acute Kidney Injury (chemically induced, diagnosis, epidemiology)
• Contrast Media (adverse effects)
• Drug-Eluting Stents
• Female
• Hemorrhage (chemically induced)
• Humans
• Male
• Myocardial Infarction
• Percutaneous Coronary Intervention (adverse effects)
• Prospective Studies
• Renal Insufficiency, Chronic (complications)
• Risk Factors
• Thrombosis (etiology)
• Treatment Outcome