title: A comparison between two different definitions of contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: BACKGROUND
  Contrast-induced acute kidney injury (CI-AKI) is associated with significantly increased mortality after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). The prognostic value of CI-AKI depends on the definitions used to define it. We compare the predictive accuracy of long-term mortality of two definitions of CI-AKI on consecutive patients undergoing pPCI for STEMI.
  
  
  METHODS
  Incidence, risk factors and long-term prognosis of CI-AKI were assessed according to two different definitions: the first as an increase in serum creatinine ≥ 25% or ≥ 0.5 mg/dl from baseline within 72 h after pPCI (contrast-induced nephropathy (CIN) criteria), the second one according to Acute Kidney Injury Network (AKIN) classification system.
  
  
  RESULTS
  A total of 402 patients were enrolled. The median follow-up period was 12 ± 4 months. Long-term mortality rate was 9.5%. Independent predictors of long-term mortality were: older age, basal renal impairment, left ventricular ejection fraction <40%, in-hospital major bleedings and CI-AKI. A significant correlation was found between mortality and CI-AKI as assessed by both CIN (HR 4.84, 95% CI: 2.56-9.16, p=0.000) and AKIN (HR 9.70, 95% CI: 5.12-18.37, p=0.000) definitions. The area under the receiver operating curve was significantly larger for predicting mortality with AKIN classification than with CIN criteria (0.7984 versus 0.7759; p=0.0331).
  
  
  CONCLUSIONS
  In patients with STEMI treated by pPCI, CI-AKI is a frequent complication irrespective of the criteria used for its definition. AKIN, however, seems to provide a better accuracy in predicting long-term mortality than CIN criteria.
authors.affiliation: Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy. Electronic address: marco.centola@ao-sanpaolo.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Centola
authors.affiliation: Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Lucreziotti
authors.affiliation: Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Salerno-Uriarte
authors.affiliation: Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Sponzilli
authors.affiliation: Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Ferrante
authors.affiliation: Nextbit s.r.l., Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Acquaviva
authors.affiliation: Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Castini
authors.affiliation: Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Spina
authors.affiliation: Cardiovascular Disease Unit, Fondazione IRCCS, Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Lombardi
authors.affiliation: Renal Division, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
authors.affiliation: Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Carugo
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000601:surgery*
chemical_list: D003287:Contrast Media
keywords: Contrast-induced acute kidney injury; Myocardial infarction; Primary angioplasty