title: Impact of contrast-induced acute kidney injury on outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: OBJECTIVE
  The purpose of this study was to identify predictors of contrast-induced acute kidney injury (CI-AKI) and the effect of CI-AKI on cardiovascular outcomes after hospital discharge in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  We retrospectively reviewed 194 STEMI consecutive patients who underwent primary PCI to evaluate the predictors for CI-AKI and 187 survivors to examine all-cause mortality and cardiovascular events. Outcomes were compared between patients with CI-AKI and those without CI-AKI, which was defined as an increase >50% or >0.5mg/dl in serum creatinine concentration within 48hours after primary PCI.
  
  
  RESULTS
  CI-AKI occurred in 23 patients (11.9%). Multivariate analysis identified pre-procedural renal insufficiency as a predictor of CI-AKI, and this predictor was independent from hemodynamic instability and excessive contrast volume. Receiver-operator characteristics analysis demonstrated that patients with an estimated glomerular filtration rate (eGFR) of ≤43.6ml/min per 1.73m(2) had the potential for CI-AKI. Patients who developed CI-AKI had higher mortality and cardiovascular events than did those without CI-AKI (27.8% vs. 4.7%; log-rank P=.0003, 27.8% vs. 11.2%; log-rank P=.0181, respectively). Cox proportional hazards model analysis identified CI-AKI as the independent predictor of mortality and cardiovascular events [hazard ratio [HR]=5.36; P=.0076, HR=3.10; P=.0250, respectively].
  
  
  CONCLUSIONS
  The risk of CI-AKI is increased in patients with pre-procedural renal insufficiency, and eGFR is clinically useful in the emergent setting for CI-AKI risk stratification before primary PCI.
authors.affiliation: Cardiovascular Division, Osaka Minami Medical Center, Osaka 586-8521, Japan. Electronic address: k_kume@ommc-hp.jp.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kume
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Yasuoka
authors.forename: Hidenori
authors.initials: H
authors.lastname: Adachi
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Noda
authors.forename: Susumu
authors.initials: S
authors.lastname: Hattori
authors.forename: Ryo
authors.initials: R
authors.lastname: Araki
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Kohama
authors.forename: Takahiro
authors.initials: T
authors.lastname: Imanaka
authors.forename: Ryo
authors.initials: R
authors.lastname: Matsutera
authors.forename: Motohiro
authors.initials: M
authors.lastname: Kosugi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Sasaki
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000401:mortality; D003404:Creatinine / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine
keywords: Contrast-induced acute kidney injury; Primary percutaneous coronary intervention; Renal insufficiency; ST-segment elevation myocardial infarction