Relation of contrast-induced nephropathy to long-term mortality after percutaneous coronary intervention
Mitsuru Abe1, Takeshi Morimoto2, Masaharu Akao1
1Division of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Insights
Contrast-induced nephropathy (CIN) significantly increases long-term mortality risk in patients with chronic kidney disease (CKD) after percutaneous coronary intervention. CIN did not impact long-term survival in patients without CKD.
Area of Science:
- Nephrology
- Cardiology
- Clinical Research
Background:
- Contrast-induced nephropathy (CIN) is a complication of percutaneous coronary intervention (PCI).
- Limited data exists on the long-term mortality impact of CIN in patients with or without chronic kidney disease (CKD).
Purpose of the Study:
- To investigate the association between CIN and long-term mortality after PCI.
- To differentiate the impact of CIN on mortality in patients with and without pre-existing CKD.
Main Methods:
- Analysis of 4,371 patients from the Coronary REvascularization Demonstrating Outcome Study in Kyoto registry with paired serum creatinine measurements.
- CIN defined as an increase in serum creatinine (SCr) of ≥0.5 mg/dl from baseline.
- Median follow-up of 42.3 months, with adjusted hazard ratios (HR) calculated for long-term mortality.
Main Results:
- The overall incidence of CIN was 5%, with higher rates in patients with CKD (11%) compared to those without (2%).
- CIN was significantly correlated with increased long-term mortality in the entire cohort (HR 2.26) and in patients with CKD (HR 2.62).
- No significant correlation between CIN and long-term mortality was observed in patients without CKD (HR 1.23).
Conclusions:
- CIN is a significant predictor of long-term mortality in patients undergoing PCI, particularly those with pre-existing CKD.
- The prognostic impact of CIN on long-term mortality differs based on CKD status.
Abstract:
There is little information on the effect of contrast-induced nephropathy (CIN) on long-term mortality after percutaneous coronary intervention in patients with or without chronic kidney disease (CKD). Of 4,371 patients who had paired serum creatinine (SCr) measurements before and after percutaneous coronary intervention and were discharged alive in the Coronary REvascularization Demonstrating Outcome Study in Kyoto registry, the incidence of CIN (an increase in SCr of ≥0.5 mg/dl from the baseline) was 5% in our study cohort. The rate of CIN in patients with CKD was 11%, although it was 2% without CKD (p <0.0001). During a median follow-up of 42.3 months after discharge, 374 patients (8.6%) died. After adjustment for prespecified confounders, CIN was significantly correlated with long-term mortality in the entire cohort (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.62 to 2.29, p <0.0001) and in patients with CKD (HR 2.62, 95% CI 1.91 to 3.57, p <0.0001) but not in patients without CKD (HR 1.23, 95% CI 0.47 to 2.62, p = 0.6). Sensitivity analyses confirmed these results using the criteria defined as elevations of the SCr by ≥25% and 0.3 mg/dl from the baseline, respectively. In conclusion, CIN was significantly correlated with long-term mortality in patients with CKD but not in those without CKD.
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