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Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry.
JACC Cardiovasc Interv 2014; 7(1):1-9JC

Abstract

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.

Authors+Show Affiliations

Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; University of Colorado Denver, Denver, Colorado. Electronic address: thomas.tsai@coloradooutcomes.org.Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina.Stanford School of Medicine, Palo Alto, California.Mid America Heart Institute, Kansas City, Missouri; University of Missouri at Kansas City School of Medicine, Kansas City, Missouri.Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.Tennessee Valley Health System VA, Nashville, Tennessee; Vanderbilt University Medical Center, Nashville, Tennessee.Mid America Heart Institute, Kansas City, Missouri; University of Missouri at Kansas City School of Medicine, Kansas City, Missouri.Mid America Heart Institute, Kansas City, Missouri; University of Missouri at Kansas City School of Medicine, Kansas City, Missouri.Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Denver VA Medical Center, Denver, Colorado.Mid America Heart Institute, Kansas City, Missouri; University of Missouri at Kansas City School of Medicine, Kansas City, Missouri.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24456715

Citation

Tsai, Thomas T., et al. "Contemporary Incidence, Predictors, and Outcomes of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions: Insights From the NCDR Cath-PCI Registry." JACC. Cardiovascular Interventions, vol. 7, no. 1, 2014, pp. 1-9.
Tsai TT, Patel UD, Chang TI, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv. 2014;7(1):1-9.
Tsai, T. T., Patel, U. D., Chang, T. I., Kennedy, K. F., Masoudi, F. A., Matheny, M. E., ... Spertus, J. A. (2014). Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC. Cardiovascular Interventions, 7(1), pp. 1-9. doi:10.1016/j.jcin.2013.06.016.
Tsai TT, et al. Contemporary Incidence, Predictors, and Outcomes of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions: Insights From the NCDR Cath-PCI Registry. JACC Cardiovasc Interv. 2014;7(1):1-9. PubMed PMID: 24456715.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: 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, PY - 2013/04/26/received PY - 2013/06/06/accepted PY - 2014/1/25/entrez PY - 2014/1/25/pubmed PY - 2014/9/30/medline KW - ACC KW - AKI KW - AKI-D KW - AKIN KW - Acute Kidney Injury Network KW - American College of Cardiology KW - CI KW - CKD KW - MI KW - NCDR KW - National Cardiovascular Data Registry KW - OR KW - PCI KW - ST-segment elevation myocardial infarction KW - STEMI KW - acute kidney injury KW - acute kidney injury requiring dialysis KW - chronic kidney disease KW - confidence interval KW - eGFR KW - estimated glomerular filtration rate KW - myocardial infarction KW - odds ratio KW - percutaneous coronary intervention KW - stent(s) SP - 1 EP - 9 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 7 IS - 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. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/24456715/Contemporary_incidence_predictors_and_outcomes_of_acute_kidney_injury_in_patients_undergoing_percutaneous_coronary_interventions:_insights_from_the_NCDR_Cath_PCI_registry_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(13)01560-4 DB - PRIME DP - Unbound Medicine ER -