Impact of contrast-induced acute kidney injury with transient or persistent renal dysfunction on long-term outcomes of patients with acute myocardial infarction undergoing percutaneous coronary intervention

Abstract

Objective To investigate the long-term prognostic implications of contrast-induced acute kidney injury (CI-AKI) with transient or persistent renal dysfunction in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). Design A retrospective observational registry study. Setting Clinical follow-up after PCI. Patients and methods A total of 1041 PCI-treated AMI patients from the Infarction Prognosis Study registry. CI-AKI was defined as an increase in serum creatinine (>25% or >0.5 mg/dl (>44.2 mmol/l)) within 2 days after PCI. Main outcome measures Two-year cumulative event rate of all-cause death or renal failure requiring dialysis. Results CI-AKI was observed in 148 patients (14.2%). Patients with CI-AKI had a higher rate of death or dialysis (25.4% vs 6.3%, p<0.001) at 2 years compared with patients without CI-AKI. CI-AKI was an important independent predictor of death or dialysis (HR 2.76, 95% CI 1.61 to 4.73, p<0.001) Persistent renal dysfunction after CI-AKI was documented in 68 patients (45.9%). Patients with transient renal dysfunction showed a lower 2-year event rate of death or dialysis compared with those with persistent renal dysfunction (17.9% vs 34.1%, p¼0.013); however, they showed a higher event rate compared with those without CI-AKI (17.9% vs 6.3%, p<0.001). Conclusion Transient and persistent renal dysfunction after CI-AKI was associated with increased short and longterm mortality and morbidity in AMI patients treated by PCI. Better preventive strategies are needed to improve clinical outcomes in AMI patients at high risk of developing CI-AKI.Contrast-induced acute kidney injury (CI-AKI) is generally considered a reversible form of acute renal failure that begins soon after iodinated contrast administration during angiographic procedures. This hospital-acquired complication is of great concern because of its adverse effects on patients' clinical outcomes, including prolonged hospitalisation and increased morbidity and mortality.1 2 Important predisposing factors for CI-AKI include female gender, older age, diabetes mellitus, pre-existing renal insufficiency, advanced heart failure and intravascular volume depletion. 3e5 The risk of CI-AKI is significantly higher among patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) than among the general population undergoing elective PCI. 6e10 The most likely contributing factors for CI-AKI in patients with AMI are haemodynamic instability or impaired systemic perfusion caused by left ventricular dysfunction, large volume of contrast medium, or insufficient time to perform renal prophylactic therapies during contrast medium exposure. 7 The purpose of this study was to determine the incidence of CI-AKI in patients with AMI undergoing PCI and to evaluate clinical predictors and long-term prognostic implications of CI-AKI in these patients. METHODS Study populationThe registry of the Infarction Prognosis Study, a prospective single-centre cohort study, is maintai...

Impact of Acute Kidney Injury on In-Hospital Outcomes of Patients With Acute Myocardial Infarction ― Results From the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) Substudy ―

“…In addition to contrast-induced nephropathy, 4,5 links between renal dysfunction and oxidative stress, inflammation, altered cytokine levels, platelet activation, and hypercoagulable or thromboresistant state have been confirmed, and these data on the course of AKI (whether AKI resolved or persisted) and the need for hemodialysis or renal replacement therapy during or after the index hospitalization, which have significant prognostic implications. 8 Fourth, the sample size for stratified analysis in Killip class 4 might have been too small to show an association between AKI and in-hospital mortality, although there was a marginally significant association on multivariate analysis. Finally, the volume of contrast agent used during coronary angiography and PCI was not available in this study.…”

Pre-Procedural Risk Score of Contrast-Induced Nephropathy in Elderly Patients Undergoing Elective Coronary Angiography

“…Another study 16) stated that CIN was significantly correlated with long-term mortality in the entire cohort and in patients with chronic kidney disease (CKD) but not in patients without CKD. A study 17) on AMI patients undergoing PCI showed that patients with transient renal dysfunction had a lower two-year event rate of death or dialysis compared with those with persistent renal dysfunction, but a higher event rate compared with those without CIN. Farhan, et al 18) revealed that advanced deterioration in renal function after PCI is an independent predictor for in-hospital and long-term mortality rates.…”

Association Between Acute Kidney Injury and In-Hospital Mortality in Patients Undergoing Percutaneous Coronary Interventions

“…[1][2][3] Although AKI is generally a reversible condition, patients developing this complication post PCI may experience up to 20-fold increase in their in-hospital mortality risk. 4 Interpretation of results reported by previous studies on the association between AKI and mortality post PCI is hampered by the fact that both outcomes share common risk factors, such as hemodynamic instability, heart failure, diabetes mellitus, and preexisting chronic kidney disease.…”