Development and Validation of a Pre-Percutaneous Coronary Intervention Risk Model of Contrast-Induced Acute Kidney Injury With an Integer Scoring System

Inohara, Taku; Kohsaka, Shun; Abe, Takayuki; Matsubara, Hiroaki; Numasawa, Yohei; Ueda, Ikuko; Nishi, Yutaro; Naito, Kunihiko; Shibata, Masaru; Hayashida, Kentaro; Maekawa, Yuichiro; Kawamura, Akio; Sato, Yuji; Fukuda, Keiichi

doi:10.1016/j.amjcard.2015.03.004

Cited by 41 publications

(42 citation statements)

References 20 publications

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“…The incidence of CI-AKI in our study is significantly lower than the incidence of CI-AKI among patients with cardiovascular disease undergoing coronary arteriography (range 7.8–15.7%)7 9 19 20 but is consistent with other studies of patients with stroke undergoing cerebral angiography (range 1.5–5.0%) 21–23. Several factors may explain the difference in incidence of CI-AKI between cerebral angiography and coronary arteriography.…”

Section: Discussionsupporting

confidence: 91%

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Proteinuria as an independent risk factor for contrast-induced acute kidney injury and mortality in patients with stroke undergoing cerebral angiography

Tao

Dong

et al. 2016

J NeuroIntervent Surg

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BackgroundThe correlation between proteinuria and contrast-induced acute kidney injury (CI-AKI) in patients with cerebrovascular disease is still unknown.ObjectiveTo determine whether proteinuria is a risk factor for CI-AKI and death in patients with stroke undergoing cerebral angiography.MethodsData from 2015 patients with stroke undergoing cerebral angiography between January 2009 and December 2013 were retrospectively collected. Clinical parameters were obtained from the hospital's computerized database. All variables were analyzed by univariate analysis and multivariate logistic regression analysis.ResultsCI-AKI was seen in 85 patients (4.2%). After adjustment for potential confounding risk factors, patients with proteinuria had a fivefold higher risk of CI-AKI than patients without proteinuria (OR=5.74; 95% CI 2.23 to 14.83; p<0.001). Other independent risk factors for CI-AKI were estimated glomerular filtration rate <60 mL/min/1.73 m2, anemia, and a high National Institute of Health Stroke Scale score. Proteinuria did not increase in-hospital mortality (OR=1.25; 95% CI 0.49 to 3.17; p=0.639) but did increase 1-year mortality (HR=2.30, 95% CI 1.55 to 3.41, p<0.001).ConclusionsProteinuria is an independent risk factor for CI-AKI and 1-year mortality in patients with stroke undergoing cerebral angiography. More attention should be paid to the development of CI-AKI in patients with stroke with proteinuria.

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Section: Discussionsupporting

confidence: 91%

“…The patients in our study presented with a lower proportion of diabetes and hyperlipidemia. In addition, the contrast volume in our study was less than that used in the previous study for coronary arteriography 7 9 19 20…”

Section: Discussionmentioning

confidence: 70%

Proteinuria as an independent risk factor for contrast-induced acute kidney injury and mortality in patients with stroke undergoing cerebral angiography

Tao

Dong

et al. 2016

J NeuroIntervent Surg

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“…What is more, most of the models evaluate the radiological interventional procedure‐related variables; thus, they complete risk assessment only after CM administration. As far as we know, there have been only 4 published models that studied the risk factors before coronary angiography . Among the 4 models, only Liu et al developed a preprocedural model in 728 Chinese patients with chronic total occlusion undergoing percutaneous coronary intervention, but common variables such as those related to diabetes were not included in the model, so it is not particularly applicable to a diabetes population.…”

Section: Introductionmentioning

confidence: 99%

Preprocedural Prediction Model for Contrast‐Induced Nephropathy Patients

Guan

et al. 2017

JAHA

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BackgroundSeveral models have been developed for prediction of contrast‐induced nephropathy (CIN); however, they only contain patients receiving intra‐arterial contrast media for coronary angiographic procedures, which represent a small proportion of all contrast procedures. In addition, most of them evaluate radiological interventional procedure‐related variables. So it is necessary for us to develop a model for prediction of CIN before radiological procedures among patients administered contrast media.Methods and ResultsA total of 8800 patients undergoing contrast administration were randomly assigned in a 4:1 ratio to development and validation data sets. CIN was defined as an increase of 25% and/or 0.5 mg/dL in serum creatinine within 72 hours above the baseline value. Preprocedural clinical variables were used to develop the prediction model from the training data set by the machine learning method of random forest, and 5‐fold cross‐validation was used to evaluate the prediction accuracies of the model. Finally we tested this model in the validation data set. The incidence of CIN was 13.38%. We built a prediction model with 13 preprocedural variables selected from 83 variables. The model obtained an area under the receiver‐operating characteristic (ROC) curve (AUC) of 0.907 and gave prediction accuracy of 80.8%, sensitivity of 82.7%, specificity of 78.8%, and Matthews correlation coefficient of 61.5%. For the first time, 3 new factors are included in the model: the decreased sodium concentration, the INR value, and the preprocedural glucose level.ConclusionsThe newly established model shows excellent predictive ability of CIN development and thereby provides preventative measures for CIN.

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“…JCD‐KiCS is a prospective, multicenter registry designed to collect clinical variables and outcomes data on consecutive patients undergoing PCI for both acute and nonacute indications using dedicated clinical research coordinators at each site 8, 9, 10, 11, 12, 13, 14. The clinical variables and in‐hospital outcomes for the JCD‐KiCS were aligned with the data elements of the National Cardiovascular Data Registry CathPCI Registry v4.1 15, 16.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Impact of Subsequent Acute Coronary Syndrome and Unplanned Revascularization on Long‐Term Mortality After an Index Percutaneous Coronary Intervention: A Report From a Japanese Multicenter Registry

Inohara

Kohsaka

Matsubara

et al. 2017

JAHA

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BackgroundWhereas composite end points are often used in clinical trials of percutaneous coronary interventions (PCI), the impact of individual components on subsequent survival is incompletely defined. We evaluated the association of subsequent acute coronary syndromes (ACS) and unplanned coronary revascularization post‐PCI with long‐term survival.Methods and ResultsFrom 2009 to 2011, the KiCS‐PCI (Keio interhospital Cardiovascular Studies) consecutively enrolled patients undergoing PCI in 14 Japanese teaching hospitals. We identified patients who experienced ACS or unplanned coronary revascularization following their index PCI and compared subsequent survival during the 2‐year follow‐up period using propensity‐matched cohorts of patients who did and did not experience these events. Cox proportional hazard models were used to assess 2‐year all‐cause mortality. Because unstable angina is less severe than acute myocardial infarction, we also generated a separate propensity‐matched cohort for UA post‐PCI. Among 3348 PCI patients (mean age, 67.5±10.7 years; 79.7% male), 214 (6.4%) experienced a subsequent ACS (168 events [78.5%] were unstable angina), and 198 (5.9%) underwent unplanned revascularization. In the propensity‐matched cohorts, patients with a subsequent ACS admission had an increased risk of mortality as compared with those without (hazard ratio, 4.73; 95% confidence interval=1.35–16.6; P=0.015), whereas those with an unplanned revascularization did not have significantly higher risk (hazard ratio, 2.97; 95% confidence interval=0.57–14.3; P=0.19). Among unstable angina events, no association with mortality was observed (hazard ratio, 1.39; 95% confidence interval=0.48–4.00; P=0.54).ConclusionsIn the KiCS‐PCI registry, the incidence of a subsequent ACS was associated with higher mortality, but this association was less apparent after unplanned coronary revascularization or unstable angina. The prognostic implications of different outcomes in a composite end point should be considered when interpreting the results of clinical trials in PCI.

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Development and Validation of a Pre-Percutaneous Coronary Intervention Risk Model of Contrast-Induced Acute Kidney Injury With an Integer Scoring System

Cited by 41 publications

References 20 publications

Proteinuria as an independent risk factor for contrast-induced acute kidney injury and mortality in patients with stroke undergoing cerebral angiography

Proteinuria as an independent risk factor for contrast-induced acute kidney injury and mortality in patients with stroke undergoing cerebral angiography

Preprocedural Prediction Model for Contrast‐Induced Nephropathy Patients

Prognostic Impact of Subsequent Acute Coronary Syndrome and Unplanned Revascularization on Long‐Term Mortality After an Index Percutaneous Coronary Intervention: A Report From a Japanese Multicenter Registry

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