Contrast-induced acute kidney injury after primary percutaneous coronary intervention: Results from the HORIZONS-AMI substudy

Amar Narula, Roxana Mehran, Giora Weisz, George D. Dangas, Jennifer Yu, Philippe Généreux, Eugenia Nikolsky, Sorin J. Brener, Bernhard Witzenbichler, Giulio Guagliumi, Avery E. Clark, Martin Fahy, Ke Xu, Bruce R. Brodie, Gregg W. Stone

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Abstract

Aim We sought to examine the short-and long-term outcomes of patients who developed contrast-induced acute kidney injury (CI-AKI; defined as an increase in serum creatinine of ≥0.5 mg/dL or a 25% relative rise within 48 h after contrast exposure) from the large-scale HORIZONS-AMI trial. Methods and results Multivariable analyses were used to identify predictors of CI-AKI, as well predictors of the primary and secondary endpoints. The incidence of CI-AKI in this cohort of ST-segment elevation myocardial infarction (STEMI) patients was 16.1% (479/2968). Predictors of CI-AKI were contrast volume, white blood cell count, left anterior descending infarct-related artery, age, anaemia, creatinine clearance <60 mL/min, and history of congestive heart failure. Patients with CI-AKI had higher rates of net adverse clinical events [NACE; a combination of major bleeding or composite major adverse cardiac events (MACE; consisting of death, reinfarction, target vessel revascularization for ischaemia, or stroke)] at 30 days (22.0 vs. 9.3%; P < 0.0001) and 3 years (40.3 vs. 24.6%; P < 0.0001). They also had higher rates of mortality at 30 days (8.0 vs. 0.9%; P < 0.0001) and 3 years (16.2 vs. 4.5%; P < 0.0001). Multivariable analysis confirmed CI-AKI as an independent predictor of NACE [hazard ratio ([HR), 1.53; 95% confidence interval (CI), 1.23-1.90; P = 0.0001], MACE (HR, 1.56; 95% CI, 1.23-1.98; P = 0.0002), non-coronary artery bypass grafting major bleeding (HR, 2.07; 95% CI, 1.57-2.73; P < 0.0001), and mortality (HR, 1.80; 95% CI, 1.19-2.73; P = 0.005) at 3-year follow-up. Conclusion Contrast-induced acute kidney injury is associated with poor short-and long-term outcomes after primary percutaneous coronary intervention in STEMI.

Original languageEnglish (US)
Pages (from-to)1533-1540
Number of pages8
JournalEuropean Heart Journal
Volume35
Issue number23
DOIs
StatePublished - Jun 14 2014

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Percutaneous Coronary Intervention
Acute Kidney Injury
Confidence Intervals
Creatinine
Arteries
Hemorrhage
Mortality
Leukocyte Count
Anemia
Ischemia
Heart Failure
Stroke
Myocardial Infarction
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Narula, Amar ; Mehran, Roxana ; Weisz, Giora ; Dangas, George D. ; Yu, Jennifer ; Généreux, Philippe ; Nikolsky, Eugenia ; Brener, Sorin J. ; Witzenbichler, Bernhard ; Guagliumi, Giulio ; Clark, Avery E. ; Fahy, Martin ; Xu, Ke ; Brodie, Bruce R. ; Stone, Gregg W. / Contrast-induced acute kidney injury after primary percutaneous coronary intervention : Results from the HORIZONS-AMI substudy. In: European Heart Journal. 2014 ; Vol. 35, No. 23. pp. 1533-1540.
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title = "Contrast-induced acute kidney injury after primary percutaneous coronary intervention: Results from the HORIZONS-AMI substudy",
abstract = "Aim We sought to examine the short-and long-term outcomes of patients who developed contrast-induced acute kidney injury (CI-AKI; defined as an increase in serum creatinine of ≥0.5 mg/dL or a 25{\%} relative rise within 48 h after contrast exposure) from the large-scale HORIZONS-AMI trial. Methods and results Multivariable analyses were used to identify predictors of CI-AKI, as well predictors of the primary and secondary endpoints. The incidence of CI-AKI in this cohort of ST-segment elevation myocardial infarction (STEMI) patients was 16.1{\%} (479/2968). Predictors of CI-AKI were contrast volume, white blood cell count, left anterior descending infarct-related artery, age, anaemia, creatinine clearance <60 mL/min, and history of congestive heart failure. Patients with CI-AKI had higher rates of net adverse clinical events [NACE; a combination of major bleeding or composite major adverse cardiac events (MACE; consisting of death, reinfarction, target vessel revascularization for ischaemia, or stroke)] at 30 days (22.0 vs. 9.3{\%}; P < 0.0001) and 3 years (40.3 vs. 24.6{\%}; P < 0.0001). They also had higher rates of mortality at 30 days (8.0 vs. 0.9{\%}; P < 0.0001) and 3 years (16.2 vs. 4.5{\%}; P < 0.0001). Multivariable analysis confirmed CI-AKI as an independent predictor of NACE [hazard ratio ([HR), 1.53; 95{\%} confidence interval (CI), 1.23-1.90; P = 0.0001], MACE (HR, 1.56; 95{\%} CI, 1.23-1.98; P = 0.0002), non-coronary artery bypass grafting major bleeding (HR, 2.07; 95{\%} CI, 1.57-2.73; P < 0.0001), and mortality (HR, 1.80; 95{\%} CI, 1.19-2.73; P = 0.005) at 3-year follow-up. Conclusion Contrast-induced acute kidney injury is associated with poor short-and long-term outcomes after primary percutaneous coronary intervention in STEMI.",
author = "Amar Narula and Roxana Mehran and Giora Weisz and Dangas, {George D.} and Jennifer Yu and Philippe G{\'e}n{\'e}reux and Eugenia Nikolsky and Brener, {Sorin J.} and Bernhard Witzenbichler and Giulio Guagliumi and Clark, {Avery E.} and Martin Fahy and Ke Xu and Brodie, {Bruce R.} and Stone, {Gregg W.}",
year = "2014",
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Narula, A, Mehran, R, Weisz, G, Dangas, GD, Yu, J, Généreux, P, Nikolsky, E, Brener, SJ, Witzenbichler, B, Guagliumi, G, Clark, AE, Fahy, M, Xu, K, Brodie, BR & Stone, GW 2014, 'Contrast-induced acute kidney injury after primary percutaneous coronary intervention: Results from the HORIZONS-AMI substudy', European Heart Journal, vol. 35, no. 23, pp. 1533-1540. https://doi.org/10.1093/eurheartj/ehu063

Contrast-induced acute kidney injury after primary percutaneous coronary intervention : Results from the HORIZONS-AMI substudy. / Narula, Amar; Mehran, Roxana; Weisz, Giora; Dangas, George D.; Yu, Jennifer; Généreux, Philippe; Nikolsky, Eugenia; Brener, Sorin J.; Witzenbichler, Bernhard; Guagliumi, Giulio; Clark, Avery E.; Fahy, Martin; Xu, Ke; Brodie, Bruce R.; Stone, Gregg W.

In: European Heart Journal, Vol. 35, No. 23, 14.06.2014, p. 1533-1540.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Contrast-induced acute kidney injury after primary percutaneous coronary intervention

T2 - Results from the HORIZONS-AMI substudy

AU - Narula, Amar

AU - Mehran, Roxana

AU - Weisz, Giora

AU - Dangas, George D.

AU - Yu, Jennifer

AU - Généreux, Philippe

AU - Nikolsky, Eugenia

AU - Brener, Sorin J.

AU - Witzenbichler, Bernhard

AU - Guagliumi, Giulio

AU - Clark, Avery E.

AU - Fahy, Martin

AU - Xu, Ke

AU - Brodie, Bruce R.

AU - Stone, Gregg W.

PY - 2014/6/14

Y1 - 2014/6/14

N2 - Aim We sought to examine the short-and long-term outcomes of patients who developed contrast-induced acute kidney injury (CI-AKI; defined as an increase in serum creatinine of ≥0.5 mg/dL or a 25% relative rise within 48 h after contrast exposure) from the large-scale HORIZONS-AMI trial. Methods and results Multivariable analyses were used to identify predictors of CI-AKI, as well predictors of the primary and secondary endpoints. The incidence of CI-AKI in this cohort of ST-segment elevation myocardial infarction (STEMI) patients was 16.1% (479/2968). Predictors of CI-AKI were contrast volume, white blood cell count, left anterior descending infarct-related artery, age, anaemia, creatinine clearance <60 mL/min, and history of congestive heart failure. Patients with CI-AKI had higher rates of net adverse clinical events [NACE; a combination of major bleeding or composite major adverse cardiac events (MACE; consisting of death, reinfarction, target vessel revascularization for ischaemia, or stroke)] at 30 days (22.0 vs. 9.3%; P < 0.0001) and 3 years (40.3 vs. 24.6%; P < 0.0001). They also had higher rates of mortality at 30 days (8.0 vs. 0.9%; P < 0.0001) and 3 years (16.2 vs. 4.5%; P < 0.0001). Multivariable analysis confirmed CI-AKI as an independent predictor of NACE [hazard ratio ([HR), 1.53; 95% confidence interval (CI), 1.23-1.90; P = 0.0001], MACE (HR, 1.56; 95% CI, 1.23-1.98; P = 0.0002), non-coronary artery bypass grafting major bleeding (HR, 2.07; 95% CI, 1.57-2.73; P < 0.0001), and mortality (HR, 1.80; 95% CI, 1.19-2.73; P = 0.005) at 3-year follow-up. Conclusion Contrast-induced acute kidney injury is associated with poor short-and long-term outcomes after primary percutaneous coronary intervention in STEMI.

AB - Aim We sought to examine the short-and long-term outcomes of patients who developed contrast-induced acute kidney injury (CI-AKI; defined as an increase in serum creatinine of ≥0.5 mg/dL or a 25% relative rise within 48 h after contrast exposure) from the large-scale HORIZONS-AMI trial. Methods and results Multivariable analyses were used to identify predictors of CI-AKI, as well predictors of the primary and secondary endpoints. The incidence of CI-AKI in this cohort of ST-segment elevation myocardial infarction (STEMI) patients was 16.1% (479/2968). Predictors of CI-AKI were contrast volume, white blood cell count, left anterior descending infarct-related artery, age, anaemia, creatinine clearance <60 mL/min, and history of congestive heart failure. Patients with CI-AKI had higher rates of net adverse clinical events [NACE; a combination of major bleeding or composite major adverse cardiac events (MACE; consisting of death, reinfarction, target vessel revascularization for ischaemia, or stroke)] at 30 days (22.0 vs. 9.3%; P < 0.0001) and 3 years (40.3 vs. 24.6%; P < 0.0001). They also had higher rates of mortality at 30 days (8.0 vs. 0.9%; P < 0.0001) and 3 years (16.2 vs. 4.5%; P < 0.0001). Multivariable analysis confirmed CI-AKI as an independent predictor of NACE [hazard ratio ([HR), 1.53; 95% confidence interval (CI), 1.23-1.90; P = 0.0001], MACE (HR, 1.56; 95% CI, 1.23-1.98; P = 0.0002), non-coronary artery bypass grafting major bleeding (HR, 2.07; 95% CI, 1.57-2.73; P < 0.0001), and mortality (HR, 1.80; 95% CI, 1.19-2.73; P = 0.005) at 3-year follow-up. Conclusion Contrast-induced acute kidney injury is associated with poor short-and long-term outcomes after primary percutaneous coronary intervention in STEMI.

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