A comparison between two different definitions of contrast-induced acute kidney injury in patients with ST-segment
Marco Centola1, Stefano Lucreziotti1, Diego Salerno-Uriarte1
1Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy.
Insights
Contrast-induced acute kidney injury (CI-AKI) following primary percutaneous coronary intervention for ST-elevation myocardial infarction is common. The Acute Kidney Injury Network (AKIN) definition better predicts long-term mortality compared to contrast-induced nephropathy (CIN) criteria.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Contrast-induced acute kidney injury (CI-AKI) increases mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI).
- The prognostic value of CI-AKI is definition-dependent.
- This study compares the predictive accuracy of two CI-AKI definitions for long-term mortality.
Purpose of the Study:
- To compare the predictive accuracy of contrast-induced nephropathy (CIN) criteria and the Acute Kidney Injury Network (AKIN) classification for long-term mortality in STEMI patients treated with pPCI.
Main Methods:
- Assessed incidence, risk factors, and long-term prognosis of CI-AKI using two definitions: CIN criteria (serum creatinine increase ≥ 25% or ≥ 0.5 mg/dl within 72h) and AKIN classification.
- Analyzed data from 402 consecutive STEMI patients undergoing pPCI.
Main Results:
- Long-term mortality was 9.5% at a median follow-up of 12 months.
- Independent predictors of mortality included older age, baseline renal impairment, low ejection fraction, major bleeding, and CI-AKI.
- Both CIN and AKIN definitions identified CI-AKI as a significant predictor of mortality (HR 4.84 for CIN, HR 9.70 for AKIN).
- The AKIN classification demonstrated a significantly larger area under the receiver operating curve for predicting mortality compared to CIN criteria (0.7984 vs. 0.7759, p=0.0331).
Conclusions:
- CI-AKI is a frequent complication in STEMI patients treated with pPCI, regardless of the definition used.
- The AKIN classification appears to offer superior accuracy in predicting long-term mortality compared to CIN criteria.
Background:
Contrast-induced acute kidney injury (CI-AKI) is associated with significantly increased mortality after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). The prognostic value of CI-AKI depends on the definitions used to define it. We compare the predictive accuracy of long-term mortality of two definitions of CI-AKI on consecutive patients undergoing pPCI for STEMI.
Methods:
Incidence, risk factors and long-term prognosis of CI-AKI were assessed according to two different definitions: the first as an increase in serum creatinine ≥ 25% or ≥ 0.5 mg/dl from baseline within 72 h after pPCI (contrast-induced nephropathy (CIN) criteria), the second one according to Acute Kidney Injury Network (AKIN) classification system.
Results:
A total of 402 patients were enrolled. The median follow-up period was 12 ± 4 months. Long-term mortality rate was 9.5%. Independent predictors of long-term mortality were: older age, basal renal impairment, left ventricular ejection fraction <40%, in-hospital major bleedings and CI-AKI. A significant correlation was found between mortality and CI-AKI as assessed by both CIN (HR 4.84, 95% CI: 2.56-9.16, p=0.000) and AKIN (HR 9.70, 95% CI: 5.12-18.37, p=0.000) definitions. The area under the receiver operating curve was significantly larger for predicting mortality with AKIN classification than with CIN criteria (0.7984 versus 0.7759; p=0.0331).
Conclusions:
In patients with STEMI treated by pPCI, CI-AKI is a frequent complication irrespective of the criteria used for its definition. AKIN, however, seems to provide a better accuracy in predicting long-term mortality than CIN criteria.
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