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Association of contrast-induced acute kidney injury with long-term cardiovascular events in acute coronary syndrome patients with chronic kidney disease undergoing emergent percutaneous coronary intervention.
Int J Cardiol. 2014 Jun 01; 174(1):57-63.IJ

Abstract

BACKGROUND

The association between contrast-induced acute kidney injury (CI-AKI) and chronic kidney disease (CKD) in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) has not been fully reported. We evaluated the association of CI-AKI on cardiovascular events in ACS patients with CKD.

METHODS

A total of 1059 ACS patients who underwent emergent PCI in our multicenter registry were enrolled (69±12 years, 804 men, 604 STEMI patients). CKD was defined as at least stage 3 CKD, and CI-AKI was defined as an increase of at least 0.5 mg/dL and/or an increase of at least 25% of pre-PCI to post-PCI serum creatinine levels within 1 week after the procedure. Primary endpoints included cardiovascular death, myocardial infarction, and cerebrovascular disorder (stroke or transient ischemic attack).

RESULTS

In our study, 368 (34.7%) patients had CKD. During follow-up periods (435±330 days), CI-AKI and primary endpoints occurred in 164 (15.5%) patients and 106 (10.0%) patients, respectively. Multivariate Cox proportional hazards model revealed that age, female gender, peak creatinine kinase>4000, IABP use, CI-AKI (hazard ratio [HR], 2.17; 95% confidential interval [CI], 1.52 to 4.00; P<0.001), and CKD (HR, 1.66; 95% CI, 1.01 to 2.72; P=0.046) were independent predictors of primary endpoints. Kaplan-Meier analysis showed that occurrence of primary endpoints increased significantly with an increase in CKD stage, and CI-AKI yielded worse long-term prognosis at every stage of CKD (P<0.001).

CONCLUSIONS

CI-AKI was revealed to be a significant incremental predictor of cardiovascular events at each stage of CKD in ACS patients.

Authors+Show Affiliations

Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan. Electronic address: asato@md.tsukuba.ac.jp.Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan.Department of Cardiology, Ibaraki Prefectural Central Hospital, Tomobe, Japan.Department of Cardiology, Ibaraki Prefectural Central Hospital, Tomobe, Japan.Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan.Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24726211

Citation

Watabe, Hiroaki, et al. "Association of Contrast-induced Acute Kidney Injury With Long-term Cardiovascular Events in Acute Coronary Syndrome Patients With Chronic Kidney Disease Undergoing Emergent Percutaneous Coronary Intervention." International Journal of Cardiology, vol. 174, no. 1, 2014, pp. 57-63.
Watabe H, Sato A, Hoshi T, et al. Association of contrast-induced acute kidney injury with long-term cardiovascular events in acute coronary syndrome patients with chronic kidney disease undergoing emergent percutaneous coronary intervention. Int J Cardiol. 2014;174(1):57-63.
Watabe, H., Sato, A., Hoshi, T., Takeyasu, N., Abe, D., Akiyama, D., Kakefuda, Y., Nishina, H., Noguchi, Y., & Aonuma, K. (2014). Association of contrast-induced acute kidney injury with long-term cardiovascular events in acute coronary syndrome patients with chronic kidney disease undergoing emergent percutaneous coronary intervention. International Journal of Cardiology, 174(1), 57-63. https://doi.org/10.1016/j.ijcard.2014.03.146
Watabe H, et al. Association of Contrast-induced Acute Kidney Injury With Long-term Cardiovascular Events in Acute Coronary Syndrome Patients With Chronic Kidney Disease Undergoing Emergent Percutaneous Coronary Intervention. Int J Cardiol. 2014 Jun 1;174(1):57-63. PubMed PMID: 24726211.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of contrast-induced acute kidney injury with long-term cardiovascular events in acute coronary syndrome patients with chronic kidney disease undergoing emergent percutaneous coronary intervention. AU - Watabe,Hiroaki, AU - Sato,Akira, AU - Hoshi,Tomoya, AU - Takeyasu,Noriyuki, AU - Abe,Daisuke, AU - Akiyama,Daiki, AU - Kakefuda,Yuki, AU - Nishina,Hidetaka, AU - Noguchi,Yuichi, AU - Aonuma,Kazutaka, Y1 - 2014/03/28/ PY - 2013/11/02/received PY - 2014/02/27/revised PY - 2014/03/21/accepted PY - 2014/4/15/entrez PY - 2014/4/15/pubmed PY - 2015/1/3/medline KW - Acute coronary syndrome KW - Chronic kidney disease KW - Contrast-induced acute kidney injury KW - Percutaneous coronary intervention KW - Prognosis SP - 57 EP - 63 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 174 IS - 1 N2 - BACKGROUND: The association between contrast-induced acute kidney injury (CI-AKI) and chronic kidney disease (CKD) in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) has not been fully reported. We evaluated the association of CI-AKI on cardiovascular events in ACS patients with CKD. METHODS: A total of 1059 ACS patients who underwent emergent PCI in our multicenter registry were enrolled (69±12 years, 804 men, 604 STEMI patients). CKD was defined as at least stage 3 CKD, and CI-AKI was defined as an increase of at least 0.5 mg/dL and/or an increase of at least 25% of pre-PCI to post-PCI serum creatinine levels within 1 week after the procedure. Primary endpoints included cardiovascular death, myocardial infarction, and cerebrovascular disorder (stroke or transient ischemic attack). RESULTS: In our study, 368 (34.7%) patients had CKD. During follow-up periods (435±330 days), CI-AKI and primary endpoints occurred in 164 (15.5%) patients and 106 (10.0%) patients, respectively. Multivariate Cox proportional hazards model revealed that age, female gender, peak creatinine kinase>4000, IABP use, CI-AKI (hazard ratio [HR], 2.17; 95% confidential interval [CI], 1.52 to 4.00; P<0.001), and CKD (HR, 1.66; 95% CI, 1.01 to 2.72; P=0.046) were independent predictors of primary endpoints. Kaplan-Meier analysis showed that occurrence of primary endpoints increased significantly with an increase in CKD stage, and CI-AKI yielded worse long-term prognosis at every stage of CKD (P<0.001). CONCLUSIONS: CI-AKI was revealed to be a significant incremental predictor of cardiovascular events at each stage of CKD in ACS patients. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/24726211/Association_of_contrast_induced_acute_kidney_injury_with_long_term_cardiovascular_events_in_acute_coronary_syndrome_patients_with_chronic_kidney_disease_undergoing_emergent_percutaneous_coronary_intervention_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(14)00582-8 DB - PRIME DP - Unbound Medicine ER -