title: Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy.
abstract: OBJECTIVE
  We sought to examine the short- and long-term outcomes of patients who developed contrast-induced acute kidney injury (CI-AKI; defined as an increase in serum creatinine of ≥0.5 mg/dL or a 25% relative rise within 48 h after contrast exposure) from the large-scale HORIZONS-AMI trial.
  
  
  RESULTS
  Multivariable analyses were used to identify predictors of CI-AKI, as well predictors of the primary and secondary endpoints. The incidence of CI-AKI in this cohort of ST-segment elevation myocardial infarction (STEMI) patients was 16.1% (479/2968). Predictors of CI-AKI were contrast volume, white blood cell count, left anterior descending infarct-related artery, age, anaemia, creatinine clearance <60 mL/min, and history of congestive heart failure. Patients with CI-AKI had higher rates of net adverse clinical events [NACE; a combination of major bleeding or composite major adverse cardiac events (MACE; consisting of death, reinfarction, target vessel revascularization for ischaemia, or stroke)] at 30 days (22.0 vs. 9.3%; P < 0.0001) and 3 years (40.3 vs. 24.6%; P < 0.0001). They also had higher rates of mortality at 30 days (8.0 vs. 0.9%; P < 0.0001) and 3 years (16.2 vs. 4.5%; P < 0.0001). Multivariable analysis confirmed CI-AKI as an independent predictor of NACE [hazard ratio ([HR), 1.53; 95% confidence interval (CI), 1.23-1.90; P = 0.0001], MACE (HR, 1.56; 95% CI, 1.23-1.98; P = 0.0002), non-coronary artery bypass grafting major bleeding (HR, 2.07; 95% CI, 1.57-2.73; P < 0.0001), and mortality (HR, 1.80; 95% CI, 1.19-2.73; P = 0.005) at 3-year follow-up.
  
  
  CONCLUSIONS
  Contrast-induced acute kidney injury is associated with poor short- and long-term outcomes after primary percutaneous coronary intervention in STEMI.
authors.affiliation: NYU Langone Medical Center, New York, NY, USA.
authors.forename: Amar
authors.initials: A
authors.lastname: Narula
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA Cardiovascular Research Foundation, New York, NY, USA roxana.mehran@mountsinai.org.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Cardiovascular Research Foundation, New York, NY, USA Columbia University Medical Center, New York, NY, USA Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yu
authors.affiliation: Cardiovascular Research Foundation, New York, NY, USA Columbia University Medical Center, New York, NY, USA Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.affiliation: Rambam Health Care Campus and the Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Nikolsky
authors.affiliation: Cardiovascular Research Foundation, New York, NY, USA New York Methodist Hospital, Brooklyn, NY, USA.
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.affiliation: Amper Kliniken AG, Dachau, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.affiliation: Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.affiliation: The Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Avery E
authors.initials: AE
authors.lastname: Clark
authors.affiliation: Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.affiliation: Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: LeBauer Cardiovascular Research Foundation and Moses Cone Heart and Vascular Center, Greensboro, NC, USA.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.affiliation: Cardiovascular Research Foundation, New York, NY, USA Columbia University Medical Center, New York, NY, USA.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D009994:Osmolar Concentration; D062645:Percutaneous Coronary Intervention; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D012008:Recurrence; D015607:Stents; D020521:Stroke / Q000139:chemically induced; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: Contrast media; Kidney; Myocardial infarction