title: Association of contrast-induced acute kidney injury with long-term cardiovascular events in acute coronary syndrome patients with chronic kidney disease undergoing emergent percutaneous coronary intervention.
abstract: BACKGROUND
  The association between contrast-induced acute kidney injury (CI-AKI) and chronic kidney disease (CKD) in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) has not been fully reported. We evaluated the association of CI-AKI on cardiovascular events in ACS patients with CKD.
  
  
  METHODS
  A total of 1059 ACS patients who underwent emergent PCI in our multicenter registry were enrolled (69±12 years, 804 men, 604 STEMI patients). CKD was defined as at least stage 3 CKD, and CI-AKI was defined as an increase of at least 0.5 mg/dL and/or an increase of at least 25% of pre-PCI to post-PCI serum creatinine levels within 1 week after the procedure. Primary endpoints included cardiovascular death, myocardial infarction, and cerebrovascular disorder (stroke or transient ischemic attack).
  
  
  RESULTS
  In our study, 368 (34.7%) patients had CKD. During follow-up periods (435±330 days), CI-AKI and primary endpoints occurred in 164 (15.5%) patients and 106 (10.0%) patients, respectively. Multivariate Cox proportional hazards model revealed that age, female gender, peak creatinine kinase>4000, IABP use, CI-AKI (hazard ratio [HR], 2.17; 95% confidential interval [CI], 1.52 to 4.00; P<0.001), and CKD (HR, 1.66; 95% CI, 1.01 to 2.72; P=0.046) were independent predictors of primary endpoints. Kaplan-Meier analysis showed that occurrence of primary endpoints increased significantly with an increase in CKD stage, and CI-AKI yielded worse long-term prognosis at every stage of CKD (P<0.001).
  
  
  CONCLUSIONS
  CI-AKI was revealed to be a significant incremental predictor of cardiovascular events at each stage of CKD in ACS patients.
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Watabe
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan. Electronic address: asato@md.tsukuba.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hoshi
authors.affiliation: Department of Cardiology, Ibaraki Prefectural Central Hospital, Tomobe, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Takeyasu
authors.affiliation: Department of Cardiology, Ibaraki Prefectural Central Hospital, Tomobe, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Abe
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Akiyama
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kakefuda
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Nishina
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Noguchi
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D058186:Acute Kidney Injury / Q000139:chemically induced*; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D003287:Contrast Media
keywords: Acute coronary syndrome; Chronic kidney disease; Contrast-induced acute kidney injury; Percutaneous coronary intervention; Prognosis