Validated Contemporary Risk Model of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions: Insights From the National Cardiovascular Data Registry Cath‐PCI Registry

Tsai, Thomas T.; Patel, Uptal D.; Chang, Tara I.; Kennedy, Kevin F.; Masoudi, Frederick A.; Matheny, Michael E.; Kosiborod, Mikhail; Amin, Amit P.; Weintraub, William S.; Curtis, Jeptha P.; Messenger, John C.; Rumsfeld, John S.; Spertus, John A.

doi:10.1161/jaha.114.001380

Cited by 182 publications

(181 citation statements)

References 43 publications

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“…4,15 In our analysis, we expand on these findings by identifying blood transfusion and bleeding as other strong predictors of AKI in PCI patients. In a comparative assessment, we demonstrated that blood transfusion was the strongest predictor of AKI in patients with anemia at baseline and without a postprocedure bleeding event and in patients without anemia at baseline but who did suffer a bleeding event.…”

Section: Discussionmentioning

confidence: 99%

“…Variables included in the model were age, preprocedure creatinine, prior cerebrovascular disease, prior heart failure, diabetes mellitus, anemia (hemoglobin <10 mg/dL), weeks HF, intraaortic balloon pump before procedure, and contrast volume, based on previously developed CathPCI registry models for post-PCI AKI. 4,15 The unadjusted and adjusted odds ratios (ORs) of the association of blood transfusion with AKI for the overall sample and the subgroups (ST-segment-elevation myocardial infarction, and unstable angina/non-ST-segment-elevation myocardial infarction ) are presented. In addition, analysis was performed to determine the association between blood transfusion and AKI among patients who did or did not have reported postprocedure bleeding events.…”

Section: Discussionmentioning

confidence: 99%

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Blood Transfusion and the Risk of Acute Kidney Injury Among Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Karrowni

Vora

Dai

et al. 2016

Circ: Cardiovascular Interventions

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A cute kidney injury (AKI) is one of the most common adverse events after percutaneous coronary intervention (PCI) and is of prognostic significance.1,2 Risk factors for its development have been the focus of multiple studies, and several patient-related and procedure-related factors have been identified. 3,4 However, no prior studies have considered the risks of periprocedural blood transfusion.There are many pathophysiological mechanisms by which blood transfusion might cause AKI, which are mainly related to impaired tissue oxygen delivery, and inflammation and oxidative stress. 5 Recently, blood transfusion has been identified as a risk factor for AKI in cardiac surgery 5,6 and in transcatheter aortic valve replacement. 7 Patients undergoing PCI are prone to bleeding given the invasive nature of the procedure and the use of antithrombotic and antiplatelet agents. Transfusion is relatively commonly used in these patients, and there is considerable variation in blood transfusion practices among patients undergoing PCI at the US hospitals. 8 The appropriate use of transfusion in this patient population might be influenced by its effect on AKI.Anemia is well-recognized as a risk factor for AKI, 9 and recently periprocedural bleeding in PCI patients was also identified to be associated with AKI. 10 However, the relationship between anemia, bleeding, and transfusion and the risk of AKI has not been well studied. Further characterization of this relationship and definition of other risk factors might help broaden prophylactic strategies against post-PCI AKI.In this cohort of patients with acute coronary syndrome (ACS) who underwent PCI, we aimed to (1) assess the association of blood transfusion with AKI and (2) characterize this relationship with anemia and bleeding. MethodsThe National Cardiovascular Data Registry (NCDR)-CathPCI Registry is the largest ongoing registry of PCI in the United States, Background-Acute kidney injury (AKI) complicating percutaneous coronary intervention (PCI) is associated with adverse clinical outcomes. To date, no studies have evaluated the association of blood transfusion with AKI in patients undergoing PCI. Methods and Results-We used a retrospective cohort study of all patients with acute coronary syndrome undergoing PCI from CathPCI Registry (n=1 756 864). The primary outcome was AKI defined as the rise in serum creatinine post procedure ≥0.5 mg/dL or ≥25% above baseline values. AKI developed in 9.0% of study sample. Patients with AKI were older, more often women, and had high prevalence of comorbidities, including diabetes mellitus, hypertension, and advanced stages of chronic kidney disease at baseline. Blood transfusion was utilized in 2.2% of patients. In the overall sample, AKI developed in 35.1% of patients who received transfusion versus 8.4% of patients without transfusion (adjusted odds ratio, 4.87 [4.71-5.04]). In the subgroup of patients who sustained bleeding event and received transfusion, the rate of AKI was significantly increased across all preprocedure hemoglobin...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Blood Transfusion and the Risk of Acute Kidney Injury Among Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Karrowni

Vora

Dai

et al. 2016

Circ: Cardiovascular Interventions

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“…We repeated each of these analyses for the secondary outcomes of bleeding complications at 72 hours using a validated predictive model for bleeding,(19) and new requirement for dialysis using a validated predictive model for post-PCI renal failure. (20) For all analyses, an OR < 1 indicates that lower PCI operator volume is associated with lower odds of the outcome compared with higher operator volume, and an OR > 1 indicates that lower PCI operator volume is associated with higher odds of the outcome compared with higher operator volume.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States

Zakroysky

Dai

Wojdyla

et al. 2017

Journal of the American College of Cardiology

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124

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Background Professional guidelines have reduced the recommended minimum number to an average of 50 PCI procedures performed annually by each operator. Operator volume patterns and associated outcomes since this change are unknown. Objectives To describe PCI operator procedure volumes; characteristics of low-, intermediate-, and high-volume operators; and the relationship between operator volume and clinical outcomes in a large, contemporary, nationwide sample Methods Using data from the nationally representative NCDR CathPCI registry collected between July 1, 2009 and March 31, 2015, we examined operator annual PCI volume. We divided operators into low- (< 50 PCIs/year), intermediate- (50–100 PCIs/year), and high-volume (> 100 PCIs/year) groups, and determined the adjusted association between annual PCI volume and in-hospital outcomes, including mortality. Results The median number of annual procedures performed per operator was 59 (25th, 75th percentiles: 21, 106); 44% of operators performed < 50 PCI procedures/year. Low-volume operators more frequently performed emergency and primary PCI procedures and practiced at hospitals with lower annual PCI volumes. Unadjusted in-hospital mortality was 1.86% for low-volume operators, 1.73% for intermediate-volume operators, and 1.53% for high-volume operators. The adjusted risk of in-hospital mortality was higher for PCI procedures performed by low- and intermediate-volume operators compared with those performed by high-volume operators (adjusted OR 1.16, 95% CI 1.12–1.21 for low vs. high; adjusted OR 1.05, 95% CI 1.02–1.09 for intermediate vs. high volume) as was the risk for new dialysis post PCI. No volume relationship was seen for post-PCI bleeding. Conclusions Many PCI operators in the U.S. are performing fewer than the recommended number of PCI procedures annually. Though absolute risk differences are small and may be partially explained by unmeasured differences in case mix between operators, there remains an inverse relationship between PCI operator volume and in-hospital mortality that persisted in risk-adjusted analyses.

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“…3). Multivariate Cox-regression models using established risk factors for MAKE [27], that were significantly different in the observed cohort stratified into no MAKE or MAKE (Table 3), were calculated to demonstrate an independent association between plasma kynurenine ≥ 3.5 µmol/L and an elevated risk for MAKE (Table 5). Model A used baseline GFR, congestive heart failure, anemia, age, contrast media volume, elective or emergency coronary angiography, and current smoking status as covariates (chi-squared=33.250, p=0.00002) .…”

Section: Resultsmentioning

confidence: 99%

Pre-Interventional Kynurenine Predicts Medium-Term Outcome after Contrast Media Exposure Due to Coronary Angiography

Reichetzeder

Heunisch

Einem

et al. 2017

Kidney Blood Press Res

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Background/Aims: Contrast induced acute kidney injury (CI-AKI) remains a serious complication of contrast media enhanced procedures like coronary angiography. There is still a lack of established biomarkers that help to identify patients at high risk for short and long-term complications. The aim of the current study was to evaluate plasma kynurenine as a predictive biomarker for CI-AKI and long-term complications, measured by the combined endpoint "major adverse kidney events" (MAKE) up to 120 days after CM application. Methods: In this prospective cohort study 245 patients undergoing coronary angiography were analyzed. Blood samples were obtained at baseline, 24h and 48h after contrast media (CM) application to diagnose CI-AKI. Patients were followed for 120 days for adverse clinical events including death, the need for dialysis, and a doubling of plasma creatinine. Occurrence of any of these events was summarized in the combined endpoint MAKE. Results: Preinterventional plasma kynurenine was not associated with CI-AKI. Patients who later developed MAKE displayed significantly increased preinterventional plasma kynurenine levels (p<0.0001). ROC analysis revealed that preinterventional kynurenine is highly predictive for MAKE (AUC=0.838; p<0.0001). The optimal cutoff was found at ≥3.5 µmol/L Using this cutoff, the Kaplan-Meier estimator demonstrated that concentrations of plasma kynurenine ≥3.5 µmol/L were significantly associated with a higher prevalence of MAKE until follow up (p<0.0001). This association remained significant in multivariate Cox regression models adjusted for relevant factors of long-term renal outcome. Conclusion: Preinterventional plasma kynurenine might serve as a highly predictive biomarker for MAKE up to 120 days after coronary angiography.

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Validated Contemporary Risk Model of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions: Insights From the National Cardiovascular Data Registry Cath‐PCI Registry

Cited by 182 publications

References 43 publications

Blood Transfusion and the Risk of Acute Kidney Injury Among Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Blood Transfusion and the Risk of Acute Kidney Injury Among Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States

Pre-Interventional Kynurenine Predicts Medium-Term Outcome after Contrast Media Exposure Due to Coronary Angiography

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