Long-Term Clinical Impact of Contrast-Associated Acute Kidney Injury Following PCI: An ADAPT-DES Substudy.
JACC Cardiovasc Interv
; 15(7): 753-766, 2022 04 11.
Article
en En
| MEDLINE
| ID: mdl-35305904
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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Trombosis
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Insuficiencia Renal Crónica
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Stents Liberadores de Fármacos
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Lesión Renal Aguda
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Intervención Coronaria Percutánea
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Infarto del Miocardio
Tipo de estudio:
Clinical_trials
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Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Female
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Humans
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Male
Idioma:
En
Revista:
JACC Cardiovasc Interv
Asunto de la revista:
ANGIOLOGIA
/
CARDIOLOGIA
Año:
2022
Tipo del documento:
Article
País de afiliación:
Estados Unidos