title: Impact of Contrast-Induced Acute Kidney Injury After Percutaneous Coronary Intervention on Short- and Long-Term Outcomes: Pooled Analysis From the HORIZONS-AMI and ACUITY Trials.
abstract: BACKGROUND
  Contrast-induced acute kidney injury (CI-AKI), defined as a serum creatinine increase ≥0.5 mg/dL or ≥25% within 72 hours after contrast exposure, is a common complication of procedures requiring contrast media and is associated with increased short- and long-term morbidity and mortality. Few studies describe the effects of CI-AKI in a large-scale acute coronary syndrome population, and the relationship between CI-AKI and bleeding events has not been extensively explored. We sought to evaluate the impact of CI-AKI after percutaneous coronary intervention in patients presenting with acute coronary syndrome.
  
  
  RESULTS
  We pooled patient-level data for 9512 patients from the percutaneous coronary intervention cohorts of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) and Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) multicenter randomized trials. Patients were classified according to CI-AKI development, and cardiovascular outcomes at 30 days and 1 year were compared between groups. A total of 1212 patients (12.7%) developed CI-AKI. Patients with CI-AKI were older, with a more extensive comorbidity profile than without CI-AKI. Multivariable analysis confirmed several previously identified predictors of CI-AKI, including diabetes mellitus, contrast volume, age, and baseline hemoglobin. Mortality rates were significantly higher in the CI-AKI group at 30 days (4.9% versus 0.7%; P<0.0001) and 1 year (9.8% versus 2.9%; P<0.0001), as were rates of 1-year myocardial infarction, definite/probable stent thrombosis, target lesion revascularization, and major adverse cardiac events. Major bleeding (13.8% versus 5.4%; hazard ratio, 2.64; 95% confidence interval, 2.21-3.15; P<0.0001) was also higher in patients with CI-AKI. After multivariable adjustment, results were unchanged.
  
  
  CONCLUSIONS
  CI-AKI after percutaneous coronary intervention in patients presenting with acute coronary syndrome is independently associated with increased risk of short- and long-term ischemic and hemorrhagic events.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00433966 (HORIZONS-AMI) and ACUITY (NCT00093158).
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
authors.forename: Daniele
authors.initials: D
authors.lastname: Giacoppo
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
authors.forename: Mahesh V
authors.initials: MV
authors.lastname: Madhavan
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
authors.forename: Josephine
authors.initials: J
authors.lastname: Warren
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
authors.forename: Sameer
authors.initials: S
authors.lastname: Bansilal
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.). rmehran@crf.org.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
mesh_terms: D054058:Acute Coronary Syndrome; D058186:Acute Kidney Injury / Q000209:etiology* / Q000235:genetics*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011897:Random Allocation; D012306:Risk; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: angioplasty; contrast media; diabetes mellitus; kidney; thrombosis