Post-contrast Acute Kidney Injury After Emergent and Elective Percutaneous Coronary Intervention (from the CREDO-Kyoto PCI/CABG Registry Cohort 3) - 01/08/23
, Mitsuru Abe, MD b, Takeshi Morimoto, MD, MPH c, Ko Yamamoto, MD a, Yuki Obayashi, MD a, Ryusuke Nishikawa, MD a, Akinori Tamura, MD a, Kazushige Kadota, MD d, Takenori Domei, MD e, Kenji Nakatsuma, MD f, Takafumi Yokomatsu, MD f, Masao Imai, MD g, Tomohiko Taniguchi, MD h, Ryuzo Nawada, MD i, Mamoru Toyofuku, MD j, Toshihiro Tamura, MD k, Tsukasa Inada, MD l, Mitsuo Matsuda, MD m, Yukihito Sato, MD g, Yutaka Furukawa, MD h, Kenji Ando, MD e, Yoshihisa Nakagawa, MD n, Takeshi Kimura, MD oon behalf of the
CREDO-Kyoto PCI/CABG Registry Cohort-3 Investigators
Résumé |
Post-contrast acute kidney injury (PC-AKI) is a common complication after percutaneous coronary intervention (PCI). However, it is unclear whether or not the effects of PC-AKI on long-term clinical outcomes were different between emergent and elective procedures. Among patients enrolled in the CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Grafting) registry cohort 3, we identified 10,822 patients treated using PCI (emergent PCI stratum: n = 5,022 [46%] and elective PCI stratum: n = 5,860 [54%]). PC-AKI was defined as ≥0.3 mg/100 ml absolute or 1.5-fold relative increase of serum creatinine within 72 hours after PCI. The incidence of PC-AKI was significantly higher after emergent PCI than after elective PCI (10.5% vs 3.7%, p <0.001). In the multivariable logistic regression model, emergent PCI was the strongest independent risk factor for PC-AKI in the entire study population. The excess adjusted risk of patients with PC-AKI relative to those without remained significant for all-cause death in both the emergent and elective PCI strata (hazard ratio 1.87, 95% confidence interval 1.59 to 2.21, p <0.001 and hazard ratio 1.31, 95% confidence interval 1.03 to 1.68, p = 0.03, respectively). There was a significant interaction between the PCI setting (emergent and elective) and the effect of PC-AKI on all-cause death, with a greater magnitude of effect in the emergent PCI stratum than in the elective PCI stratum (p for interaction = 0.01). In conclusion, the incidence of PC-AKI was 2.8 times higher after emergent PCI than after elective PCI. The excess mortality risk of PC-AKI relative to no PC-AKI was greater after emergent PCI than after elective PCI.
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| This work was supported by an educational grant from the Research Institute for Production Development (Kyoto, Japan). |
Vol 202
P. 58-66 - septembre 2023 Retour au numéro
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