Validation of a Contemporary Acute Kidney Injury Risk Score in Patients With Acute Coronary Syndrome

Area of Science:

• Cardiology
• Nephrology
• Clinical Risk Prediction

Background:

• A contemporary risk score for contrast-associated acute kidney injury (CA-AKI) post-percutaneous coronary intervention (PCI) requires external validation.
• The existing score has not been adequately tested in diverse patient populations.

Purpose of the Study:

• To externally validate the updated CA-AKI risk score in a large cohort of acute coronary syndrome (ACS) patients.
• To assess the predictive performance of 8-component and 12-component CA-AKI models.
• To investigate predictors of Kidney Disease Improving Global Outcomes (KDIGO)-based AKI and the impact of CA-AKI on mortality and bleeding.

Main Methods:

• Utilized data from the Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of angioX (MATRIX) trial, including 8,201 patients.
• Evaluated the receiver-operating characteristics (ROC) of two CA-AKI risk models.
• Analyzed independent predictors of AKI and the association of CA-AKI with 1-year mortality and bleeding events.

Main Results:

• CA-AKI occurred in 5.5% of patients, with rates increasing across the 4 risk categories.
• The area under the ROC curve was 0.67 for the 8-component model and 0.71 for the 12-component model.
• Both models systematically overestimated CA-AKI risk (P < 0.05). CA-AKI was associated with significantly higher 1-year all-cause mortality (HR: 7.03) and bleeding (HR: 3.20).

Conclusions:

• The updated CA-AKI risk score effectively stratifies patients by incremental risk of CA-AKI, bleeding, and mortality.
• The score demonstrates clinical utility in identifying high-risk individuals undergoing PCI.
• Findings support the use of this risk score for patient management and outcome prediction in ACS settings.