title: Contrast-associated AKI and use of cardiovascular medications after acute coronary syndrome.
abstract: OBJECTIVE
  AKI after coronary angiography is associated with poor long-term outcomes. The relationship between contrast-associated AKI and subsequent use of prognosis-modifying cardiovascular medications is unknown.
  
  
  METHODS
  A cohort study of 5911 participants 66 years of age or older with acute coronary syndrome who received a coronary angiogram in Alberta, Canada was performed between November 1, 2002, and November 30, 2008. AKI was identified according to Kidney Disease Improving Global Outcomes AKI criteria.
  
  
  RESULTS
  In multivariable logistic regression models, compared with participants without AKI, those with stages 1 and 2-3 AKI had lower odds of subsequent use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker within 120 days of hospital discharge (adjusted odds ratio, 0.65; 95% confidence interval, 0.53 to 0.80 and odds ratio, 0.34; 95% confidence interval, 0.23 to 0.48, respectively). Subsequent statin and β-blockers use within 120 days of hospital discharge was significantly lower among those with stages 2-3 AKI (adjusted odds ratio, 0.44; 95% confidence interval, 0.31 to 0.64 and odds ratio, 0.46; 95% confidence interval, 0.31 to 0.66, respectively). These associations were consistently seen in patients with diabetes mellitus, heart failure, low baseline eGFR, and albuminuria; 952 participants died during subsequent follow-up after hospital discharge (mean=3.1 years). The use of each class of cardiovascular medication was associated with lower mortality, including among those who had experienced AKI.
  
  
  CONCLUSIONS
  Strategies to optimize the use of cardiac medications in people with AKI after coronary angiography might improve care.
authors.affiliation: Departments of Medicine and.
authors.forename: Kelvin C W
authors.initials: KC
authors.lastname: Leung
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Neesh
authors.initials: N
authors.lastname: Pannu
authors.affiliation: Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; and.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Tan
authors.affiliation: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; and.
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
authors.affiliation: Departments of Medicine and.
authors.forename: Merril L
authors.initials: ML
authors.lastname: Knudtson
authors.affiliation: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; and.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.affiliation: Departments of Medicine and.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.affiliation: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; and mjames@ucalgary.ca.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: James
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000150:complications / Q000503:physiopathology; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D003404:Creatinine / Q000097:blood; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D003287:Contrast Media; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D003404:Creatinine
keywords: ACE inhibitors; acute renal failure; cardiovascular