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Post-contrast Acute Kidney Injury After Emergent and Elective Percutaneous Coronary Intervention (from the

Kazuhisa Kaneda1, Hiroki Shiomi1, Mitsuru Abe2

  • 1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.

The American Journal of Cardiology
|July 8, 2023
PubMed

Insights

Post-contrast acute kidney injury (PC-AKI) occurs more frequently after emergent percutaneous coronary intervention (PCI) than elective PCI. This PC-AKI significantly increases long-term mortality risk, especially following emergent procedures.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Outcomes Research

Background:

  • Post-contrast acute kidney injury (PC-AKI) is a recognized complication following percutaneous coronary intervention (PCI).
  • The differential impact of PC-AKI on long-term outcomes between emergent and elective PCI procedures remains incompletely understood.

Purpose of the Study:

  • To investigate the incidence of PC-AKI after emergent versus elective PCI.
  • To evaluate the association between PC-AKI and long-term all-cause mortality in both PCI settings.
  • To determine if the effect of PC-AKI on mortality differs between emergent and elective PCI.

Main Methods:

  • Analysis of 10,822 patients from the CREDO-Kyoto PCI/CABG registry cohort 3 undergoing PCI.
  • PC-AKI defined by serum creatinine increase within 72 hours post-PCI.
  • Multivariable logistic regression and interaction analysis to assess risk factors and outcome associations.

Main Results:

  • PC-AKI incidence was significantly higher in emergent PCI (10.5%) compared to elective PCI (3.7%).
  • Emergent PCI was the strongest independent risk factor for PC-AKI.
  • PC-AKI was associated with increased all-cause mortality in both emergent (HR 1.87) and elective (HR 1.31) PCI.
  • A significant interaction showed a greater mortality risk from PC-AKI after emergent PCI.

Conclusions:

  • The incidence of PC-AKI is substantially higher after emergent PCI.
  • PC-AKI confers a greater excess mortality risk following emergent PCI compared to elective PCI.
  • These findings highlight the importance of risk stratification and management of PC-AKI in emergent PCI settings.

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