title: Impact of periprocedural bleeding on incidence of contrast-induced acute kidney injury in patients treated with percutaneous coronary intervention.
abstract: OBJECTIVE
  This study sought to evaluate the association between contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention and severity of bleeding estimated from periprocedural hemoglobin (Hb) measurement.
  
  
  BACKGROUND
  The relationship between CI-AKI and bleeding in contemporary practice remains controversial.
  
  
  METHODS
  In a retrospective analysis of the prospectively maintained Japan Cardiovascular Database-Keio Interhospital Cardiovascular Studies (JCD-KICS) multicenter registry, we divided 2,646 consecutive patients into 5 groups according to the change of Hb level after compared with before percutaneous coronary intervention: patients without a decrease in Hb level (group A) and patients with a decreased Hb level: <1 g/dl (group B); 1 to <2 g/dl (group C); 2 to <3g/dl (group D); and >3 g/dl (group E). CI-AKI was defined as an increase in serum creatinine level ≥ 0.5 mg/dl or ≥ 25% above baseline values at 48 h after administration of contrast media. Procedure and outcome variables were compared.
  
  
  RESULTS
  The mean patient age was 67 ± 11 years. Of the 2,646 patients, CI-AKI developed in 315 (11.9%). The CI-AKI incidence was 6.2%, 7.5%, 10.7%, 17.0%, and 26.2%, in groups A through E, respectively (p < 0.01), whereas the incidence of major bleeding was 0.7%, 1.3%, 2.0%, 4.1%, and 28.3%, respectively (p < 0.01). CI-AKI was associated with higher rates of mortality (5.4% vs. 0.6%, p < 0.01) and of composite of heart failure, cardiogenic shock, and death (16.5% vs. 2.8%, p < 0.01).
  
  
  CONCLUSIONS
  Periprocedural bleeding was significantly associated with CI-AKI, with CI-AKI incidence correlating with bleeding severity.
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Ohno
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maekawa
authors.affiliation: Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Department of Cardiology, Hino Municipal Hospital, Tokyo, Japan.
authors.forename: Soushin
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Department of Cardiology, Saitama Municipal Hospital, Saitama, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Ishikawa
authors.affiliation: Department of Cardiology, Kawasaki Municipal Hospital, Kanagawa, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Sueyoshi
authors.affiliation: Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan.
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Noma
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Kawamura
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. Electronic address: kohsaka@cpnet.med.keio.ac.jp.
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000150:complications* / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D003287:Contrast Media
keywords: ACS; ANOVA; CI-AKI; CKD; Cr; DBP; Hb; MAP; PCI; SBP; acute coronary syndromes; analysis of variance; bleeding; chronic kidney disease; contrast-induced acute kidney injury; creatinine; diastolic blood pressure; eGFR; estimated glomerular ﬁltration rate; hemoglobin; mean arterial pressure; percutaneous coronary intervention; systolic blood pressure