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Incidence, prognostic impact, and optimal definition of contrast-induced acute kidney injury in consecutive patients with stable or unstable coronary artery disease undergoing percutaneous coronary intervention. insights from the all-comer PRODIGY trial.
Catheter Cardiovasc Interv 2015; 86(1):E19-27CC

Abstract

BACKGROUND

Contrast-induced acute kidney injury (CI-AKI) is associated with poor outcome. Whether this association differs in stable coronary artery disease (CAD) as compared to acute coronary syndrome (ACS) patients is unknown. Definitions and Methods: PRODIGY trial patients were defined as stable CAD or ACS according to the initial presentation. CI-AKI was defined as an increase (Δ) of serum creatinine (SCr) ≥25% above baseline. Two endpoints were considered: all-cause death and the composite of death, stroke, or myocardial infarction (MI). The interaction between CI-AKI, clinical setting, and the impact of increasing ΔSCr% cut-offs were also explored.

RESULTS

Two thousand three patients were enrolled in the PRODIGY trial, 85 patients were excluded for missing SCr data, leading to a population of 1,918 patients. CI-AKI incidence was 6.7% in stable CAD and 12.2% in ACS patients. CI-AKI was associated with all-cause mortality [adjusted hazard ratio (aHR) of 2.05, 95% confidence interval (CI) 1.38-3.05, P < 0.001] and the composite of death, stroke, or MI [aHR of 1.49, 95% CI 1.13-1.97, P < 0.001]. The risk of CI-AKI for the composite endpoint was higher in stable CAD, P for interaction: 0.048. A ΔSCr of 35% was associated with the highest aHR for all-cause mortality: 2.34 [95% CI, 1.46-3.76, P < 0.001] and the composite of death, stroke, or MI: 1.70 [95% CI, 1.20-2.40, P > 0.001].

CONCLUSIONS

In a large, contemporary, all-comers percutaneous coronary intervention population, CI-AKI was associated with an increased risk of all-cause death and the composite of death, stroke, or MI. While CI-AKI is more common in ACS than in stable CAD patients, its adjusted prognostic impact on the composite endpoint appears to be more pronounced in patients with stable CAD.

Authors+Show Affiliations

Cardiology Department, Foundation IRCCS Policlinico San Matteo, Pavia, Italy.Cardiology Department, Foundation IRCCS Policlinico San Matteo, Pavia, Italy.Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.Cardiology Department, University of Ferrara, Ferrara, Italy.Cardiology Department, University of Ferrara, Ferrara, Italy.Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

25703119

Citation

Crimi, Gabriele, et al. "Incidence, Prognostic Impact, and Optimal Definition of Contrast-induced Acute Kidney Injury in Consecutive Patients With Stable or Unstable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention. Insights From the All-comer PRODIGY Trial." Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 86, no. 1, 2015, pp. E19-27.
Crimi G, Leonardi S, Costa F, et al. Incidence, prognostic impact, and optimal definition of contrast-induced acute kidney injury in consecutive patients with stable or unstable coronary artery disease undergoing percutaneous coronary intervention. insights from the all-comer PRODIGY trial. Catheter Cardiovasc Interv. 2015;86(1):E19-27.
Crimi, G., Leonardi, S., Costa, F., Ariotti, S., Tebaldi, M., Biscaglia, S., & Valgimigli, M. (2015). Incidence, prognostic impact, and optimal definition of contrast-induced acute kidney injury in consecutive patients with stable or unstable coronary artery disease undergoing percutaneous coronary intervention. insights from the all-comer PRODIGY trial. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 86(1), pp. E19-27. doi:10.1002/ccd.25822.
Crimi G, et al. Incidence, Prognostic Impact, and Optimal Definition of Contrast-induced Acute Kidney Injury in Consecutive Patients With Stable or Unstable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention. Insights From the All-comer PRODIGY Trial. Catheter Cardiovasc Interv. 2015;86(1):E19-27. PubMed PMID: 25703119.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence, prognostic impact, and optimal definition of contrast-induced acute kidney injury in consecutive patients with stable or unstable coronary artery disease undergoing percutaneous coronary intervention. insights from the all-comer PRODIGY trial. AU - Crimi,Gabriele, AU - Leonardi,Sergio, AU - Costa,Francesco, AU - Ariotti,Sara, AU - Tebaldi,Matteo, AU - Biscaglia,Simone, AU - Valgimigli,Marco, Y1 - 2015/02/20/ PY - 2014/10/18/received PY - 2015/01/03/accepted PY - 2015/2/24/entrez PY - 2015/2/24/pubmed PY - 2016/3/24/medline KW - acute coronary syndromes KW - contrast-induced acute kidney injury KW - percutaneous coronary interventions SP - E19 EP - 27 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 86 IS - 1 N2 - BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is associated with poor outcome. Whether this association differs in stable coronary artery disease (CAD) as compared to acute coronary syndrome (ACS) patients is unknown. Definitions and Methods: PRODIGY trial patients were defined as stable CAD or ACS according to the initial presentation. CI-AKI was defined as an increase (Δ) of serum creatinine (SCr) ≥25% above baseline. Two endpoints were considered: all-cause death and the composite of death, stroke, or myocardial infarction (MI). The interaction between CI-AKI, clinical setting, and the impact of increasing ΔSCr% cut-offs were also explored. RESULTS: Two thousand three patients were enrolled in the PRODIGY trial, 85 patients were excluded for missing SCr data, leading to a population of 1,918 patients. CI-AKI incidence was 6.7% in stable CAD and 12.2% in ACS patients. CI-AKI was associated with all-cause mortality [adjusted hazard ratio (aHR) of 2.05, 95% confidence interval (CI) 1.38-3.05, P < 0.001] and the composite of death, stroke, or MI [aHR of 1.49, 95% CI 1.13-1.97, P < 0.001]. The risk of CI-AKI for the composite endpoint was higher in stable CAD, P for interaction: 0.048. A ΔSCr of 35% was associated with the highest aHR for all-cause mortality: 2.34 [95% CI, 1.46-3.76, P < 0.001] and the composite of death, stroke, or MI: 1.70 [95% CI, 1.20-2.40, P > 0.001]. CONCLUSIONS: In a large, contemporary, all-comers percutaneous coronary intervention population, CI-AKI was associated with an increased risk of all-cause death and the composite of death, stroke, or MI. While CI-AKI is more common in ACS than in stable CAD patients, its adjusted prognostic impact on the composite endpoint appears to be more pronounced in patients with stable CAD. SN - 1522-726X UR - https://www.unboundmedicine.com/medline/citation/25703119/Incidence_prognostic_impact_and_optimal_definition_of_contrast_induced_acute_kidney_injury_in_consecutive_patients_with_stable_or_unstable_coronary_artery_disease_undergoing_percutaneous_coronary_intervention__insights_from_the_all_comer_PRODIGY_trial_ L2 - https://doi.org/10.1002/ccd.25822 DB - PRIME DP - Unbound Medicine ER -