scholarly journals Evaluation of two classical contrast-induced nephropathy definitions for predicting long-term mortality in patients undergoing elective percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Lin ◽  
Z You ◽  
H Chen ◽  
C He ◽  
X Chen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cox Regression ◽  
Interaction Analysis ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Contrast Induced Nephropathy ◽  
Cox Regression Analysis ◽  
Percutaneous Coronary ◽  
Long Term Mortality

Abstract Background Contrast-induced nephropathy (CIN) is a frequent complication after percutaneous coronary intervention (PCI), and is associated with poor outcome. However, the optimal definition of CIN has been debated because of its different incidence and influence on prognosis. At present, there are limited data regarding th impact of different CIN definitions on long-term mortality in patients undergoing elective PCI. Purpose To explore the influence of two classical CIN definitions on long-term mortality and identify which definition was more suitable for predicting long-term mortality in patients undergoing elective PCI.. Methods We prospectively observed 5600 consenting patients undergoing PCI from January 2012 to December 2018. Two classical CIN definitions include those defined by ESUR[Contrast-media-induced nephrotoxicity (CMN)] and AKIN[contrast induced acute kidney injury (CI-AKI)]. CMN was defined as an increase in serum creatinine (SCr) ≥25% or 0.5 mg/dLabove thebaseline level within 3 days,while CI-AKI wasdefined as an increase in SCr ≥50% or 0.3 mg/dL within 48hs after contrast medium exposure.The association of CIN with long-term mortality was investigated by Cox regression analysis.Interaction analyses were performed for long-term mortality across subgroups. Results The incidence of CIN according to ESUR (CMN) and AKIN (CI-AKI) definition were18.3% (n=1023) and 6.1% (n=342), respectively. During a median follow-up of 2 years, after adjusting other potential risk factors, multivariable cox regression analysis revealed CIN was a risk factor for long-term mortality [hazard ratio (HR): 2.021, 95% confidence interval (CI): 1.389–2.938, P<0.0001] according to AKIN definition, but not for ESUR definition (HR: 1.344, 95% CI: 0.982–1.838, P>0.05). Further interaction analysis showed that there was a significant interaction between age >75ys and CMN for long-term mortality (P=0.042) while no such association was observed between age >75ys and CI-AKI (P=0.806). Conclusions CIN defined by AKIN may be more suitable for predicting long-term mortality in patients undergoing elective PCI. However, in elderly patients, CIN defined by ESUR could also be used for predicting long-term mortality. Association Between CIN and mortality Funding Acknowledgement Type of funding source: None

scholarly journals A Comparison Between Two Definitions of Contrast-Associated Acute Kidney Injury for Long-Term Mortality in Elderly and Non-elderly Patients After Elective Percutaneous Coronary Intervention

2021 ◽  
Vol 8 ◽  
Author(s):  
Haoming He ◽  
Zhebin You ◽  
Xueqin Lin ◽  
Chen He ◽  
Sicheng Zhang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Elderly Patients ◽  
Cox Regression ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Cox Regression Analysis ◽  
Percutaneous Coronary ◽  
Definition Of ◽  
Long Term Mortality

Background: Contrast-associated acute kidney injury (CA-AKI) is responsible for a substantial proportion of the observed mortality that occurs after percutaneous coronary intervention (PCI), particularly in elderly patients. However, there has been significant and debate over whether the optimal definition of CA-AKI persists over prolonged periods due to variations in the prevalence and effects on prognosis. In this study, we aimed to identify whether different definitions of CA-AKI exert differential impacts on long-term mortality when compared between elderly and non-elderly patients receiving elective PCI.Methods: We prospectively investigated 5,587 consenting patients undergoing elective PCI between January 2012 and December 2018. We considered two classical definitions of CA-AKI from the European Society of Urogenital Radiology (ESUR) and the Acute Kidney Injury Network (AKIN). Multivariable Cox regression analysis was used to investigate the association between CA-AKI and long-term mortality. We also performed interaction and stratified analyses according to age (≤75 or >75 years).Results: The incidence of CA-AKI according to the ESUR and AKIN definitions was 18.7 and 6.1%, respectively. After a median follow-up of 2.1 years, multivariable Cox regression analysis indicated that CA-AKI according to the AKIN definition was a risk factor for long-term mortality in the overall population [hazard ratio (HR) = 2.20; 95% confidential interval (CI): 1.51–3.22; p < 0.001]; however, this was not the case for the ESUR definition (HR = 1.27; 95% CI: 0.92–1.76; p = 0.153). Further interaction analysis identified a significant interaction between age and the ESUR definition (p = 0.040). Stratified analyses also found an association between the ESUR definition and long-term mortality in patients >75 years of age (p = 0.011), but not in patients ≤75 years of age (p = 0.657).Conclusion: As a stringent definition of CA-AKI, the AKIN definition was significantly associated with long-term mortality in both non-elderly and elderly patients. However, in elderly patients, the more lenient definition provided by the ESUR was also significantly correlated with long-term mortality, which could sensitively identify high-risk elderly patients and may provide a better alternative.

Long-term outcomes following percutaneous coronary intervention for patients with rheumatoid arthritis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Dawson ◽  
D Dinh ◽  
S.J Duffy ◽  
A Brennan ◽  
E Guymer ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
National Death Index ◽  
Long Term Outcomes ◽  
Cox Regression Analysis ◽  
Obstructive Sleep ◽  
Percutaneous Coronary ◽  
Long Term Mortality

Abstract Background Rheumatoid arthritis (RA) is the most common inflammatory arthritis and is associated with increased risk of cardiovascular events and mortality. Despite this, data regarding long-term outcomes following percutaneous coronary intervention (PCI) are limited. Methods We identified 756 patients with RA from the Melbourne Interventional Group PCI registry (2005–2018) and compared outcomes to the remaining cohort (N=38,579). Cox regression analysis was performed to assess risk of adverse cardiac events including long-term mortality (derived from linkage with the National Death Index [NDI]). Results Patients with RA were older (68.9±10.0 vs. 64.6±12.0 years) and more often female (40% vs. 23%), with higher rates of hypertension (70% vs 67%), previous stroke (9% vs 6%), peripheral vascular disease (9% vs 6%), obstructive sleep apnoea (10% vs 5%), chronic lung disease (22% vs 12%), prior myocardial infarction (32% vs 27%), and impaired renal function (eGFR<60 ml/min/1.73m2 in 31% vs 24%), while rates of current smoking were lower (20% vs. 25%), all p<0.05. Lesions were more frequently complex (ACC/AHA type B2/C in 61% vs 57%), required longer stents (>20mm in 39% vs 35%), and rates of no reflow were higher (5% vs 3%), all p<0.05. 30-day mortality was higher (4.4% vs. 3.3%, p=0.04) mainly owing to higher non-cardiac mortality (1.6% vs. 0.8%, p=0.01). National Death Index-linked long-term mortality was 28% vs. 19% (p<0.01) with mean follow-up 4.6 vs. 5.4 years. Risk of 30-day and long-term mortality (including by indication subgroup) are presented in the Table. Conclusions Patients with RA undergoing PCI have more comorbidities and longer, more complex coronary lesions. After adjustment, risk of short-term adverse outcomes are similar, while risk of long-term mortality is higher, particularly among patients with acute coronary syndromes. Funding Acknowledgement Type of funding source: None

scholarly journals The relationship between Hyperuricemia and Contrast-induced acute kidney injury undergoing primary percutaneous coronary intervention: the protocol of secondary analysis for ATTEMPT RESCIND-1 study

2019 ◽  
Author(s):  
Wei Guo ◽  
Feier Song ◽  
Shiqun Chen ◽  
Li Zhang ◽  
Guoli Sun ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Percutaneous Coronary ◽  
Long Term Mortality

Abstract Background: Contrast-induced acute kidney injury (CI-AKI) contributes toward unfavorable clinical outcomes after primary percutaneous coronary intervention (pPCI). We assessed whether hyperuricemia is an independent predictor of CI-AKI and outcomes in patients undergoing pPCI. Methods/design: Our study was a secondary analysis for the database from ATTEMPT study, enrolling 560 ST-segment elevation myocardial infarction (STEMI) patients undergoing pPCI. Eligible patients received peri-procedural either via aggressive (left ventricular end-diastolic pressure guided) or routine (<=500ml) intravenous hydration with the isotonic solution (0.9% NaCl) with randomization. The primary endpoint was CI-AKI, defined as >25% or 0.5 mg/dL increase in serum creatinine from baseline during the first 48-72 hours post-procedurally. Patients were divided into 2 groups according to the admission serum uric acid (SUA) level. Hyperuricemia was defined as a SUA level >7 mg/dL (417 mmol/L) in males and >6 mg/dL (357 mmol/L) in females. Multivariate analyses for CI-AKI and long-term mortality were performed using the logistic regression and Cox regression analyses, respectively. Discussion: This study will determine the predictive value of hyperuricemia for the development of CI-AKI and outcomes in patients with STEMI undergoing pPCI. We predict that hyperuricemia will be associated with a risk of CI-AKI in patients with pPCI. Furthermore, after adjusting for other variables, long-term mortality after pPCI was higher in those with hyperuricemia than in those with normouricemia. Results of this study may provide scientific evidence for the effect of hyperuricemia on CI-AKI and long-term outcomes, thereby offering the potential possibility of lowering SUA on the development of CI-AKI and outcomes.

P1745Clinical characteristics and long-term outcome in patients with helicopter-transported acute coronary syndrome after primary percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Takahashi ◽  
M Ogita ◽  
S Tsuboi ◽  
R Nishio ◽  
K Yasuda ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Long Term Outcome ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Long Term Mortality

Abstract Background Reducing delay to percutaneous coronary intervention improves functional outcome and reduces long-term mortality. Transportation by helicopter is often quicker than ground transport and thus may improve overall prognosis through reduced ischemic injury and infarction size. Our hospital is located on the medically-depopulated peninsula surrounded by mountain. The journey from the southern tip of the peninsula to the critical care medical center of our hospital take 1.5 hour by a ground ambulance but only 15 minutes by helicopter. We compared the clinical characteristics and long-term mortality between air and ground transport of ACS patients for primary PCI. Methods We conducted an observational cohort study evaluating 2324 patients (mean age 68.5±12.0, male 75.2%) with ACS underwent primary PCI between April 2004 and December 2017 at our hospital. We divided into three groups according to transportation system type (air, ground, walk-in). The primary outcome was defined as all-cause death during the long-term follow-up. Results Among the entire cohort, 577 patients (24.8%) were transported by air. 1326 (57.1%) patients by ambulance, 421 (18.1%) patients by walk. Baseline characteristics were comparable, but patients by air had a higher prevalence of ST-elevation myocardial infarction. The rate of long-term mortality was comparable during the median follow up of 6 years (air, 21.1% vs. ground, 21.4% vs. walk-in, 21.1%, respectively, log-rank p=0.72). Multivariate Cox regression analysis showed no significant association between air transportation and long-term mortality (Adjusted HR [vs ground] 1.05, 95% CI 0.60–1.78, p=0.85 and [vs walk-in] 0.94, 95% CI 0.62–1.43, respectively, p=0.77). Kaplan-Meier curve Conclusions The rate of long-term mortality in patients with ACS transported by air was comparable with those transported by ground.

Relation of Contrast-Induced Nephropathy to Long-Term Mortality After Percutaneous Coronary Intervention

2014 ◽  
Vol 114 (3) ◽  
pp. 362-368 ◽  
Author(s):  
Mitsuru Abe ◽  
Takeshi Morimoto ◽  
Masaharu Akao ◽  
Yutaka Furukawa ◽  
Yoshihisa Nakagawa ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Contrast Induced Nephropathy ◽  
Percutaneous Coronary ◽  
Long Term Mortality

scholarly journals Impact of KDIGO-Defined Acute Kidney Injury on Mortality after Percutaneous Coronary Intervention for Acute Myocardial Infarction

2018 ◽  
Vol 8 (4) ◽  
pp. 332-339 ◽  
Author(s):  
Vojko Kanic ◽  
Gregor Kompara ◽  
David Suran ◽  
Robert Ekart ◽  
Sebastjan Bevc ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Progressive Increase ◽  
Percutaneous Coronary ◽  
Stage 1 ◽  
Long Term Mortality

Background: There are limited data regarding the incidence and long-term impact of acute kidney injury (AKI) according to the KDIGO guidelines on the outcome in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI). The aim of the study was to evaluate the prevalence of AKI, as classified by the KDIGO criteria, and its association with long-term mortality. Methods: Data from 5,859 MI patients undergoing PCI at our institution were analyzed. We compared the group without and with AKI according to the KDIGO criteria in relation to long-term mortality. Results: AKI was documented in 499 (8.5%) patients. AKI stage 1 occurred in 6.2% of patients, AKI stage 2 in 0.9% of patients, and AKI stage 3 in 1.5% of patients. Patients with AKI had a higher long-term mortality (57.3 vs. 20.6%; p < 0.0001). The mortality was 50.3% in AKI stage 1, 56.9% in AKI stage 2, and 87.2% in AKI stage 3. The hazard ratios for all-cause mortality for AKI stages 1–3 were 1.77, 1.85, and 6.30 compared to patients with no AKI. Cardiogenic shock, bleeding, heart failure, age, renal dysfunction, diabetes, hyperlipidemia, ST-elevation MI, contrast volume/glomerular filtration ratio, P2Y12 receptor antagonists, and radial access were associated with the development of AKI. Conclusion: A slight increase in serum creatinine was associated with a progressive increase in long-term mortality in patients with AKI according to the KDIGO definition.

scholarly journals The relationship between Hyperuricemia and Contrast-induced acute kidney injury undergoing primary percutaneous coronary intervention: the protocol of secondary analysis for ATTEMPT RESCIND-1 study

2019 ◽  
Author(s):  
Wei Guo ◽  
Feier Song ◽  
Shiqun Chen ◽  
Li Zhang ◽  
Guoli Sun ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Percutaneous Coronary ◽  
Long Term Mortality

Abstract Background Contrast-induced acute kidney injury (CI-AKI) contributes toward unfavorable clinical outcomes after primary percutaneous coronary intervention (pPCI). We assessed whether hyperuricemia is an independent predictor of CI-AKI and outcomes in patients undergoing pPCI. Methods/design Our study was a secondary analysis for the database from ATTEMPT study, enrolling 560 ST-segment elevation myocardial infarction (STEMI) patients undergoing pPCI. Eligible patients received peri-procedural either via aggressive (left ventricular end-diastolic pressure guided) or routine (<=500ml) intravenous hydration with the isotonic solution (0.9% NaCl) with randomization. The primary endpoint was CI-AKI, defined as >25% or 0.5 mg/dL increase in serum creatinine from baseline during the first 48-72 hours post-procedurally. Patients were divided into 2 groups according to the admission serum uric acid (SUA) level. Hyperuricemia was defined as a SUA level >7 mg/dL (417 mmol/L) in males and >6 mg/dL (357 mmol/L) in females. Multivariate analyses for CI-AKI and long-term mortality were performed using the logistic regression and Cox regression analyses, respectively. Discussion This study will determine the predictive value of hyperuricemia for the development of CI-AKI and outcomes in patients with STEMI undergoing pPCI. We predict that hyperuricemia will be associated with a risk of CI-AKI in patients with pPCI. Furthermore, after adjusting for other variables, long-term mortality after pPCI was higher in those with hyperuricemia than in those with normouricemia. Results of this study may provide scientific evidence for the effect of hyperuricemia on CI-AKI and long-term outcomes, thereby offering the potential possibility of lowering SUA on the development of CI-AKI and outcomes.

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