Impact of contrast-induced acute kidney injury after percutaneous coronary intervention on short- and long-term outcomes

Pooled analysis from the HORIZONS-AMI and ACUITY trials

Daniele Giacoppo, Mahesh V. Madhavan, Usman Baber, Josephine Warren, Sameer Bansilal, Bernhard Witzenbichler, George D. Dangas, Ajay J. Kirtane, Ke Xu, Ran Kornowski, Sorin J. Brener, Philippe Genereux, Gregg W. Stone, Roxana Mehran

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Article numbere002475
JournalCirculation: Cardiovascular Interventions
Volume8
Issue number8
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Triage
Percutaneous Coronary Intervention
Acute Kidney Injury
Catheterization
Stents
Myocardial Infarction
Acute Coronary Syndrome
Hemorrhage
Mortality
Contrast Media
Multicenter Studies
Comorbidity
Creatinine
Diabetes Mellitus
Hemoglobins
Thrombosis
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Giacoppo, Daniele ; Madhavan, Mahesh V. ; Baber, Usman ; Warren, Josephine ; Bansilal, Sameer ; Witzenbichler, Bernhard ; Dangas, George D. ; Kirtane, Ajay J. ; Xu, Ke ; Kornowski, Ran ; Brener, Sorin J. ; Genereux, Philippe ; Stone, Gregg W. ; Mehran, Roxana. / Impact of contrast-induced acute kidney injury after percutaneous coronary intervention on short- and long-term outcomes : Pooled analysis from the HORIZONS-AMI and ACUITY trials. In: Circulation: Cardiovascular Interventions. 2015 ; Vol. 8, No. 8.
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title = "Impact of contrast-induced acute kidney injury after percutaneous coronary intervention on short- and long-term outcomes: Pooled analysis from the HORIZONS-AMI and ACUITY trials",
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.",
author = "Daniele Giacoppo and Madhavan, {Mahesh V.} and Usman Baber and Josephine Warren and Sameer Bansilal and Bernhard Witzenbichler and Dangas, {George D.} and Kirtane, {Ajay J.} and Ke Xu and Ran Kornowski and Brener, {Sorin J.} and Philippe Genereux and Stone, {Gregg W.} and Roxana Mehran",
year = "2015",
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doi = "10.1161/CIRCINTERVENTIONS.114.002475",
language = "English (US)",
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journal = "Circulation: Cardiovascular Interventions",
issn = "1941-7640",
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Giacoppo, D, Madhavan, MV, Baber, U, Warren, J, Bansilal, S, Witzenbichler, B, Dangas, GD, Kirtane, AJ, Xu, K, Kornowski, R, Brener, SJ, Genereux, P, Stone, GW & Mehran, R 2015, 'Impact of contrast-induced acute kidney injury after percutaneous coronary intervention on short- and long-term outcomes: Pooled analysis from the HORIZONS-AMI and ACUITY trials', Circulation: Cardiovascular Interventions, vol. 8, no. 8, e002475. https://doi.org/10.1161/CIRCINTERVENTIONS.114.002475

Impact of contrast-induced acute kidney injury after percutaneous coronary intervention on short- and long-term outcomes : Pooled analysis from the HORIZONS-AMI and ACUITY trials. / Giacoppo, Daniele; Madhavan, Mahesh V.; Baber, Usman; Warren, Josephine; Bansilal, Sameer; Witzenbichler, Bernhard; Dangas, George D.; Kirtane, Ajay J.; Xu, Ke; Kornowski, Ran; Brener, Sorin J.; Genereux, Philippe; Stone, Gregg W.; Mehran, Roxana.

In: Circulation: Cardiovascular Interventions, Vol. 8, No. 8, e002475, 01.01.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of contrast-induced acute kidney injury after percutaneous coronary intervention on short- and long-term outcomes

T2 - Pooled analysis from the HORIZONS-AMI and ACUITY trials

AU - Giacoppo, Daniele

AU - Madhavan, Mahesh V.

AU - Baber, Usman

AU - Warren, Josephine

AU - Bansilal, Sameer

AU - Witzenbichler, Bernhard

AU - Dangas, George D.

AU - Kirtane, Ajay J.

AU - Xu, Ke

AU - Kornowski, Ran

AU - Brener, Sorin J.

AU - Genereux, Philippe

AU - Stone, Gregg W.

AU - Mehran, Roxana

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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.

AB - 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.

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U2 - 10.1161/CIRCINTERVENTIONS.114.002475

DO - 10.1161/CIRCINTERVENTIONS.114.002475

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VL - 8

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

SN - 1941-7640

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