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Risk-Stratified Prognostic Implications of Contrast-Associated Acute Kidney Injury After Percutaneous Coronary

Takahiro Suzuki1, Shun Kohsaka2, John A Spertus3

  • 1Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan.

JACC. Advances
|July 25, 2025
PubMed

Insights

Contrast-associated acute kidney injury (CA-AKI) after percutaneous coronary intervention (PCI) is linked to worse long-term outcomes across all patient risk levels. This highlights the need for strategies to prevent CA-AKI during PCI procedures.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Contrast-associated acute kidney injury (CA-AKI) is a common complication following percutaneous coronary intervention (PCI).
  • The clinical significance of CA-AKI and its impact on long-term patient outcomes remain subjects of debate.
  • Assessing CA-AKI's association with long-term adverse events is crucial for risk stratification and management.

Purpose of the Study:

  • To evaluate the association between CA-AKI and major adverse cardiovascular events (MACE) up to two years post-PCI.
  • To analyze this association across different pre-procedural risk categories defined by the National Cardiovascular Data Registry (NCDR) AKI risk score.
  • To determine if pre-procedural risk modifies the impact of CA-AKI on long-term outcomes.

Main Methods:

  • Analysis of a Japanese registry of 7,916 patients undergoing PCI from September 2008 to October 2021.
  • Patients were stratified into low, intermediate, and high-risk groups based on NCDR AKI risk score tertiles.
  • CA-AKI was defined by creatinine increase or dialysis initiation; 2-year MACE was assessed using Cox regression.

Main Results:

  • CA-AKI developed in 9.1% of patients, with incidence rates of 2.3% (low-risk), 7.3% (intermediate-risk), and 17.9% (high-risk).
  • CA-AKI was significantly associated with an increased risk of 2-year MACE (aHR: 1.64).
  • This association was consistent across all risk categories (low-risk aHR: 2.84; intermediate-risk aHR: 1.64; high-risk aHR: 1.60), with no significant interaction effect.

Conclusions:

  • CA-AKI is associated with adverse long-term cardiovascular outcomes in patients undergoing PCI, irrespective of their baseline risk profile.
  • These findings emphasize the importance of implementing preventive measures to reduce the incidence of CA-AKI.
  • Proactive strategies to mitigate CA-AKI are essential for improving patient prognosis after PCI.
Abstract

Keywords:
contrast-associated acute kidney injurymajor adverse cardiovascular eventspercutaneous coronary interventionpreprocedural risk score

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