TY - JOUR
T1 - Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions
T2 - Insights from the NCDR cath-PCI registry
AU - Tsai, Thomas T.
AU - Patel, Uptal D.
AU - Chang, Tara I.
AU - Kennedy, Kevin F.
AU - Masoudi, Frederick A.
AU - Matheny, Michael E.
AU - Kosiborod, Mikhail
AU - Amin, Amit P.
AU - Messenger, John C.
AU - Rumsfeld, John S.
AU - Spertus, John A.
N1 - Funding Information:
Financial support was provided by the American College of Cardiology and Society for Coronary Angiography and Intervention . Dr. Kosiborod has received research grants from Medtronic Minimed, Glumetrics, Genentech, sanofi-aventis, and Gilead Sciences ; and is a consultant for and an advisory board member of Medtronic Minimed, Genentech, Roche, AstraZeneca, and Gilead Sciences. Dr. Masoudi has received monetary support from the American College of Cardiology Foundation and the Oklahoma Foundation for Medical Quality . Dr. Messenger has received a research grant from Medtronic . Dr. Spertus served on the advisory board of Gilead; and received research grants from Eli Lilly, Genentech, Amorcyte, and EvaHeart . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2014/1
Y1 - 2014/1
N2 - Objectives This study sought to examine the contemporary incidence, predictors and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions. Background Acute kidney injury (AKI) is a serious and potentially preventable complication of percutaneous coronary interventions (PCIs) that is associated with adverse outcomes. The contemporary incidence, predictors, and outcomes of AKI are not well defined, and clarifying these can help identify high-risk patients for proactive prevention. Methods A total of 985,737 consecutive patients underwent PCIs at 1,253 sites participating in the National Cardiovascular Data Registry Cath-PCI registry from June 2009 through June 2011. AKI was defined on the basis of changes in serum creatinine level in the hospital according to the Acute Kidney Injury Network (AKIN) criteria. Using multivariable regression analyses with generalized estimating equations, we identified patient characteristics associated with AKI. Results Overall, 69,658 (7.1%) patients experienced AKI, with 3,005 (0.3%) requiring new dialysis. On multivariable analyses, the factors most strongly associated with development of AKI included ST-segment elevation myocardial infarction (STEMI) presentation (odds ratio [OR]: 2.60; 95% confidence interval [CI]: 2.53 to 2.67), severe chronic kidney disease (OR: 3.59; 95% CI: 3.47 to 3.71), and cardiogenic shock (OR: 2.92; 95% CI: 2.80 to 3.04). The in-hospital mortality rate was 9.7% for patients with AKI and 34% for those requiring dialysis compared with 0.5% for patients without AKI (p < 0.001). After multivariable adjustment, AKI (OR: 7.8; 95% CI: 7.4 to 8.1, p < 0.001) and dialysis (OR: 21.7; 95% CI: 19.6 to 24.1; p < 0.001) remained independent predictors of in-hospital mortality. Conclusions Approximately 7% of patients undergoing a PCI experience AKI, which is strongly associated with in-hospital mortality. Defining strategies to minimize the risk of AKI in patients undergoing PCI are needed to improve the safety and outcomes of the procedure.
AB - Objectives This study sought to examine the contemporary incidence, predictors and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions. Background Acute kidney injury (AKI) is a serious and potentially preventable complication of percutaneous coronary interventions (PCIs) that is associated with adverse outcomes. The contemporary incidence, predictors, and outcomes of AKI are not well defined, and clarifying these can help identify high-risk patients for proactive prevention. Methods A total of 985,737 consecutive patients underwent PCIs at 1,253 sites participating in the National Cardiovascular Data Registry Cath-PCI registry from June 2009 through June 2011. AKI was defined on the basis of changes in serum creatinine level in the hospital according to the Acute Kidney Injury Network (AKIN) criteria. Using multivariable regression analyses with generalized estimating equations, we identified patient characteristics associated with AKI. Results Overall, 69,658 (7.1%) patients experienced AKI, with 3,005 (0.3%) requiring new dialysis. On multivariable analyses, the factors most strongly associated with development of AKI included ST-segment elevation myocardial infarction (STEMI) presentation (odds ratio [OR]: 2.60; 95% confidence interval [CI]: 2.53 to 2.67), severe chronic kidney disease (OR: 3.59; 95% CI: 3.47 to 3.71), and cardiogenic shock (OR: 2.92; 95% CI: 2.80 to 3.04). The in-hospital mortality rate was 9.7% for patients with AKI and 34% for those requiring dialysis compared with 0.5% for patients without AKI (p < 0.001). After multivariable adjustment, AKI (OR: 7.8; 95% CI: 7.4 to 8.1, p < 0.001) and dialysis (OR: 21.7; 95% CI: 19.6 to 24.1; p < 0.001) remained independent predictors of in-hospital mortality. Conclusions Approximately 7% of patients undergoing a PCI experience AKI, which is strongly associated with in-hospital mortality. Defining strategies to minimize the risk of AKI in patients undergoing PCI are needed to improve the safety and outcomes of the procedure.
KW - PCI
KW - acute kidney injury
KW - stent(s)
UR - http://www.scopus.com/inward/record.url?scp=84892957707&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2013.06.016
DO - 10.1016/j.jcin.2013.06.016
M3 - Article
C2 - 24456715
AN - SCOPUS:84892957707
VL - 7
SP - 1
EP - 9
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 1
ER -