Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry.
OBJECTIVE
This study sought to examine the contemporary incidence, predictors and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions.


BACKGROUND
Acute kidney injury (AKI) is a serious and potentially preventable complication of percutaneous coronary interventions (PCIs) that is associated with adverse outcomes. The contemporary incidence, predictors, and outcomes of AKI are not well defined, and clarifying these can help identify high-risk patients for proactive prevention.


METHODS
A total of 985,737 consecutive patients underwent PCIs at 1,253 sites participating in the National Cardiovascular Data Registry Cath-PCI registry from June 2009 through June 2011. AKI was defined on the basis of changes in serum creatinine level in the hospital according to the Acute Kidney Injury Network (AKIN) criteria. Using multivariable regression analyses with generalized estimating equations, we identified patient characteristics associated with AKI.


RESULTS
Overall, 69,658 (7.1%) patients experienced AKI, with 3,005 (0.3%) requiring new dialysis. On multivariable analyses, the factors most strongly associated with development of AKI included ST-segment elevation myocardial infarction (STEMI) presentation (odds ratio [OR]: 2.60; 95% confidence interval [CI]: 2.53 to 2.67), severe chronic kidney disease (OR: 3.59; 95% CI: 3.47 to 3.71), and cardiogenic shock (OR: 2.92; 95% CI: 2.80 to 3.04). The in-hospital mortality rate was 9.7% for patients with AKI and 34% for those requiring dialysis compared with 0.5% for patients without AKI (p < 0.001). After multivariable adjustment, AKI (OR: 7.8; 95% CI: 7.4 to 8.1, p < 0.001) and dialysis (OR: 21.7; 95% CI: 19.6 to 24.1; p < 0.001) remained independent predictors of in-hospital mortality.


CONCLUSIONS
Approximately 7% of patients undergoing a PCI experience AKI, which is strongly associated with in-hospital mortality. Defining strategies to minimize the risk of AKI in patients undergoing PCI are needed to improve the safety and outcomes of the procedure.
Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; University of Colorado Denver, Denver, Colorado. Electronic address: thomas.tsai@coloradooutcomes.org.
Thomas T
TT
Tsai
Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina.
Uptal D
UD
Patel
Stanford School of Medicine, Palo Alto, California.
Tara I
TI
Chang
Mid America Heart Institute, Kansas City, Missouri; University of Missouri at Kansas City School of Medicine, Kansas City, Missouri.
Kevin F
KF
Kennedy
Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
Frederick A
FA
Masoudi
Tennessee Valley Health System VA, Nashville, Tennessee; Vanderbilt University Medical Center, Nashville, Tennessee.
Michael E
ME
Matheny
Mid America Heart Institute, Kansas City, Missouri; University of Missouri at Kansas City School of Medicine, Kansas City, Missouri.
Mikhail
M
Kosiborod
Mid America Heart Institute, Kansas City, Missouri; University of Missouri at Kansas City School of Medicine, Kansas City, Missouri.
Amit P
AP
Amin
Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
John C
JC
Messenger
Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Denver VA Medical Center, Denver, Colorado.
John S
JS
Rumsfeld
Mid America Heart Institute, Kansas City, Missouri; University of Missouri at Kansas City School of Medicine, Kansas City, Missouri.
John A
JA
Spertus
D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D012042:Registries; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D015415:Biomarkers; D003404:Creatinine
ACC; AKI; AKI-D; AKIN; Acute Kidney Injury Network; American College of Cardiology; CI; CKD; MI; NCDR; National Cardiovascular Data Registry; OR; PCI; ST-segment elevation myocardial infarction; STEMI; acute kidney injury; acute kidney injury requiring dialysis; chronic kidney disease; confidence interval; eGFR; estimated glomerular filtration rate; myocardial infarction; odds ratio; percutaneous coronary intervention; stent(s)