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Association between acute kidney injury and in-hospital mortality in patients undergoing percutaneous coronary

Judith Kooiman1, Milan Seth1, Brahmajee K Nallamothu1

  • 1From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.).

Circulation. Cardiovascular Interventions
|June 7, 2015
PubMed

Insights

Acute kidney injury (AKI) after percutaneous coronary intervention (PCI) significantly increases mortality risk. Preventing AKI is crucial, as avoiding 9 cases could prevent one death, highlighting the need for new preventive strategies.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Research

Background:

  • Acute kidney injury (AKI) following percutaneous coronary intervention (PCI) is linked to higher mortality rates.
  • Common risk factors contribute to both AKI and death post-PCI.
  • The specific impact of high contrast dye volume on mortality after PCI remains unclear.

Purpose of the Study:

  • To investigate the association between AKI and in-hospital mortality after PCI.
  • To adjust for shared risk factors confounding the AKI-mortality relationship.
  • To assess the independent effect of contrast dose on mortality post-PCI.

Main Methods:

  • Analysis of a regional registry of PCI patients in Michigan (2010-2013).
  • Primary endpoints: AKI (serum creatinine increase >0.5 mg/dL) and all-cause in-hospital mortality.
  • Propensity-matched cohort analysis (1 AKI patient to 4 controls) to control for confounders.

Main Results:

  • 2.3% of 92,317 PCI patients developed AKI.
  • AKI was strongly associated with in-hospital mortality (OR=12.52).
  • AKI accounted for 31.4% of in-hospital mortality; preventing 9 AKI cases could prevent 1 death. High contrast dose showed a weak independent impact on mortality (aOR=1.19).

Conclusions:

  • AKI is a major contributor to in-hospital mortality post-PCI, responsible for nearly one-third of deaths.
  • Effective AKI prevention strategies are essential and should extend beyond contrast dose reduction.
  • Interventions to prevent AKI post-PCI could significantly reduce mortality.
Abstract

Keywords:
contrast mediainfarctionkidneymortalityrevascularization

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