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Impact of contrast-induced acute kidney injury on outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
Cardiovasc Revasc Med 2013 Sep-Oct; 14(5):253-7CR

Abstract

PURPOSE

The purpose of this study was to identify predictors of contrast-induced acute kidney injury (CI-AKI) and the effect of CI-AKI on cardiovascular outcomes after hospital discharge in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).

METHODS AND MATERIALS

We retrospectively reviewed 194 STEMI consecutive patients who underwent primary PCI to evaluate the predictors for CI-AKI and 187 survivors to examine all-cause mortality and cardiovascular events. Outcomes were compared between patients with CI-AKI and those without CI-AKI, which was defined as an increase >50% or >0.5mg/dl in serum creatinine concentration within 48hours after primary PCI.

RESULTS

CI-AKI occurred in 23 patients (11.9%). Multivariate analysis identified pre-procedural renal insufficiency as a predictor of CI-AKI, and this predictor was independent from hemodynamic instability and excessive contrast volume. Receiver-operator characteristics analysis demonstrated that patients with an estimated glomerular filtration rate (eGFR) of ≤43.6ml/min per 1.73m(2) had the potential for CI-AKI. Patients who developed CI-AKI had higher mortality and cardiovascular events than did those without CI-AKI (27.8% vs. 4.7%; log-rank P=.0003, 27.8% vs. 11.2%; log-rank P=.0181, respectively). Cox proportional hazards model analysis identified CI-AKI as the independent predictor of mortality and cardiovascular events [hazard ratio [HR]=5.36; P=.0076, HR=3.10; P=.0250, respectively].

CONCLUSIONS

The risk of CI-AKI is increased in patients with pre-procedural renal insufficiency, and eGFR is clinically useful in the emergent setting for CI-AKI risk stratification before primary PCI.

Authors+Show Affiliations

Cardiovascular Division, Osaka Minami Medical Center, Osaka 586-8521, Japan. Electronic address: k_kume@ommc-hp.jp.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

23993293

Citation

Kume, Kiyoshi, et al. "Impact of Contrast-induced Acute Kidney Injury On Outcomes in Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention." Cardiovascular Revascularization Medicine : Including Molecular Interventions, vol. 14, no. 5, 2013, pp. 253-7.
Kume K, Yasuoka Y, Adachi H, et al. Impact of contrast-induced acute kidney injury on outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiovasc Revasc Med. 2013;14(5):253-7.
Kume, K., Yasuoka, Y., Adachi, H., Noda, Y., Hattori, S., Araki, R., ... Sasaki, T. (2013). Impact of contrast-induced acute kidney injury on outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiovascular Revascularization Medicine : Including Molecular Interventions, 14(5), pp. 253-7. doi:10.1016/j.carrev.2013.07.009.
Kume K, et al. Impact of Contrast-induced Acute Kidney Injury On Outcomes in Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Cardiovasc Revasc Med. 2013;14(5):253-7. PubMed PMID: 23993293.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of contrast-induced acute kidney injury on outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. AU - Kume,Kiyoshi, AU - Yasuoka,Yoshinori, AU - Adachi,Hidenori, AU - Noda,Yoshiki, AU - Hattori,Susumu, AU - Araki,Ryo, AU - Kohama,Yasuaki, AU - Imanaka,Takahiro, AU - Matsutera,Ryo, AU - Kosugi,Motohiro, AU - Sasaki,Tatsuya, Y1 - 2013/08/28/ PY - 2013/05/31/received PY - 2013/07/22/revised PY - 2013/07/22/accepted PY - 2013/9/3/entrez PY - 2013/9/3/pubmed PY - 2014/4/23/medline KW - Contrast-induced acute kidney injury KW - Primary percutaneous coronary intervention KW - Renal insufficiency KW - ST-segment elevation myocardial infarction SP - 253 EP - 7 JF - Cardiovascular revascularization medicine : including molecular interventions JO - Cardiovasc Revasc Med VL - 14 IS - 5 N2 - PURPOSE: The purpose of this study was to identify predictors of contrast-induced acute kidney injury (CI-AKI) and the effect of CI-AKI on cardiovascular outcomes after hospital discharge in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). METHODS AND MATERIALS: We retrospectively reviewed 194 STEMI consecutive patients who underwent primary PCI to evaluate the predictors for CI-AKI and 187 survivors to examine all-cause mortality and cardiovascular events. Outcomes were compared between patients with CI-AKI and those without CI-AKI, which was defined as an increase >50% or >0.5mg/dl in serum creatinine concentration within 48hours after primary PCI. RESULTS: CI-AKI occurred in 23 patients (11.9%). Multivariate analysis identified pre-procedural renal insufficiency as a predictor of CI-AKI, and this predictor was independent from hemodynamic instability and excessive contrast volume. Receiver-operator characteristics analysis demonstrated that patients with an estimated glomerular filtration rate (eGFR) of ≤43.6ml/min per 1.73m(2) had the potential for CI-AKI. Patients who developed CI-AKI had higher mortality and cardiovascular events than did those without CI-AKI (27.8% vs. 4.7%; log-rank P=.0003, 27.8% vs. 11.2%; log-rank P=.0181, respectively). Cox proportional hazards model analysis identified CI-AKI as the independent predictor of mortality and cardiovascular events [hazard ratio [HR]=5.36; P=.0076, HR=3.10; P=.0250, respectively]. CONCLUSIONS: The risk of CI-AKI is increased in patients with pre-procedural renal insufficiency, and eGFR is clinically useful in the emergent setting for CI-AKI risk stratification before primary PCI. SN - 1878-0938 UR - https://www.unboundmedicine.com/medline/citation/23993293/Impact_of_contrast_induced_acute_kidney_injury_on_outcomes_in_patients_with_ST_segment_elevation_myocardial_infarction_undergoing_primary_percutaneous_coronary_intervention_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-8389(13)00118-8 DB - PRIME DP - Unbound Medicine ER -