Author + information
- Received April 26, 2013
- Accepted June 6, 2013
- Published online January 1, 2014.
- Thomas T. Tsai, MD, MSc∗,†∗ (, )
- Uptal D. Patel, MD‡,
- Tara I. Chang, MD, MS§,
- Kevin F. Kennedy, MS‖,¶,
- Frederick A. Masoudi, MD, MSPH∗,
- Michael E. Matheny, MD, MSc, MPH∗∗,††,
- Mikhail Kosiborod, MD‖,¶,
- Amit P. Amin, MD, MSc‖,¶,
- John C. Messenger, MD∗,
- John S. Rumsfeld, MD, PhD∗,# and
- John A. Spertus, MD, MPH‖,¶
- ∗Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
- †University of Colorado Denver, Denver, Colorado
- ‡Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
- §Stanford School of Medicine, Palo Alto, California
- ‖Mid America Heart Institute, Kansas City, Missouri
- ¶University of Missouri at Kansas City School of Medicine, Kansas City, Missouri
- #Denver VA Medical Center, Denver, Colorado
- ∗∗Tennessee Valley Health System VA, Nashville, Tennessee
- ††Vanderbilt University Medical Center, Nashville, Tennessee
- ↵∗Reprint requests and correspondence:
Dr. Thomas T. Tsai, Institute for Health Research, Kaiser Permanente Colorado, University of Colorado Denver, 280 Exempla Circle, Lafayette, Colorado 80026-3370.
Objectives This study sought to examine the contemporary incidence, predictors and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions.
Background Acute kidney injury (AKI) is a serious and potentially preventable complication of percutaneous coronary interventions (PCIs) that is associated with adverse outcomes. The contemporary incidence, predictors, and outcomes of AKI are not well defined, and clarifying these can help identify high-risk patients for proactive prevention.
Methods A total of 985,737 consecutive patients underwent PCIs at 1,253 sites participating in the National Cardiovascular Data Registry Cath-PCI registry from June 2009 through June 2011. AKI was defined on the basis of changes in serum creatinine level in the hospital according to the Acute Kidney Injury Network (AKIN) criteria. Using multivariable regression analyses with generalized estimating equations, we identified patient characteristics associated with AKI.
Results Overall, 69,658 (7.1%) patients experienced AKI, with 3,005 (0.3%) requiring new dialysis. On multivariable analyses, the factors most strongly associated with development of AKI included ST-segment elevation myocardial infarction (STEMI) presentation (odds ratio [OR]: 2.60; 95% confidence interval [CI]: 2.53 to 2.67), severe chronic kidney disease (OR: 3.59; 95% CI: 3.47 to 3.71), and cardiogenic shock (OR: 2.92; 95% CI: 2.80 to 3.04). The in-hospital mortality rate was 9.7% for patients with AKI and 34% for those requiring dialysis compared with 0.5% for patients without AKI (p < 0.001). After multivariable adjustment, AKI (OR: 7.8; 95% CI: 7.4 to 8.1, p < 0.001) and dialysis (OR: 21.7; 95% CI: 19.6 to 24.1; p < 0.001) remained independent predictors of in-hospital mortality.
Conclusions Approximately 7% of patients undergoing a PCI experience AKI, which is strongly associated with in-hospital mortality. Defining strategies to minimize the risk of AKI in patients undergoing PCI are needed to improve the safety and outcomes of the procedure.
Financial support was provided by the American College of Cardiology and Society for Coronary Angiography and Intervention. Dr. Kosiborod has received research grants from Medtronic Minimed, Glumetrics, Genentech, sanofi-aventis, and Gilead Sciences; and is a consultant for and an advisory board member of Medtronic Minimed, Genentech, Roche, AstraZeneca, and Gilead Sciences. Dr. Masoudi has received monetary support from the American College of Cardiology Foundation and the Oklahoma Foundation for Medical Quality. Dr. Messenger has received a research grant from Medtronic. Dr. Spertus served on the advisory board of Gilead; and received research grants from Eli Lilly, Genentech, Amorcyte, and EvaHeart. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 26, 2013.
- Accepted June 6, 2013.
- American College of Cardiology Foundation