Contrast-induced kidney injury: how does it affect long-term cardiac mortality?

A Andreis, C Budano, M Levis, P Garrone, T Usmiani, F D’Ascenzo, O de Filippo, Maurizio D’Amico, Laura Bergamasco, Luigi Biancone, Sebastiano Marra, A Colombo, F Gaita

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Abstract

AIMS: Contrast-induced acute kidney injury (CIAKI) is a common complication after coronary angiography or percutaneous revascularization (PCI). This study aimed to investigate the association of CIAKI with long-term cardiovascular adverse events. METHODS: In total, 980 patients undergoing coronary angiography/PCI were assessed in this prospective cohort study. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) and cardiac death (CVD) during an 8-year follow-up. Glomerular filtration rate change during the follow-up was the secondary endpoint.CIAKI was defined as a serum creatinine increase at least 0.3?mg/dl in 48?h or at least 50% in 7 days. RESULTS: CIAKI was observed in 69 patients (7%). Chronic kidney disease [relative risk (RR)?=?4, P? <?0.01], reduced ejection fraction (RR?=?2.88, P? <?0.01), CIAKI risk score at least 4 (RR?=?2.64, P?=?0.02), and emergency coronary angiography/PCI (RR?=?3.87, P? <?0.01) increased CIAKI risk, whereas statins were protective (RR?=?0.32, P? <?0.01).Patients with CIAKI had higher rates of 8-year cardiovascular adverse events: 54 versus 15% MACCE (RR?=?6.67, P? <?0.01), 38 versus 4% CVD (RR?=?15.73, P? <?0.01). Among other factors, CIAKI was the strongest predictor of 8-year MACCE (RR?=?3.16, P? <?0.01) and CVD (RR?=?7.34, P? <?0.01).During the follow-up, glomerular filtration rate declined drastically in CIAKI patients: 70 versus 39% had chronic kidney disease stage worsening (P? <?0.01) and 8 versus 0.3% started hemodialysis (P? <?0.01). CONCLUSION: We found a strong correlation between CIAKI and poor long-term cardiac outcomes. Apparently showing up as a transient, functional impairment of kidney function, CIAKI implies an organic damage with structural modifications leading to significant kidney deterioration over time, responsible for an increased risk of long-term cardiac events. Statins significantly reduced CIAKI occurrence. A careful management of high-risk patients is needed to limit long-term complications of coronary angiography/PCI. © 2017 Italian Federation of Cardiology. All rights reserved.
Original languageEnglish
Pages (from-to)908-915
Number of pages8
JournalJournal of Cardiovascular Medicine
Volume18
Issue number11
DOIs
Publication statusPublished - 2017

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Acute Kidney Injury
Kidney
Mortality
Wounds and Injuries
Coronary Angiography
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Glomerular Filtration Rate
Chronic Renal Insufficiency
Risk Management
Cardiology
Renal Dialysis
Creatinine
Emergencies
Cohort Studies
Prospective Studies

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Andreis, A., Budano, C., Levis, M., Garrone, P., Usmiani, T., D’Ascenzo, F., ... Gaita, F. (2017). Contrast-induced kidney injury: how does it affect long-term cardiac mortality? Journal of Cardiovascular Medicine, 18(11), 908-915. https://doi.org/10.2459/JCM.0000000000000543

Contrast-induced kidney injury: how does it affect long-term cardiac mortality? / Andreis, A; Budano, C; Levis, M; Garrone, P; Usmiani, T; D’Ascenzo, F; de Filippo, O; D’Amico, Maurizio; Bergamasco, Laura; Biancone, Luigi; Marra, Sebastiano; Colombo, A; Gaita, F.

In: Journal of Cardiovascular Medicine, Vol. 18, No. 11, 2017, p. 908-915.

Research output: Contribution to journalArticle

Andreis, A, Budano, C, Levis, M, Garrone, P, Usmiani, T, D’Ascenzo, F, de Filippo, O, D’Amico, M, Bergamasco, L, Biancone, L, Marra, S, Colombo, A & Gaita, F 2017, 'Contrast-induced kidney injury: how does it affect long-term cardiac mortality?', Journal of Cardiovascular Medicine, vol. 18, no. 11, pp. 908-915. https://doi.org/10.2459/JCM.0000000000000543
Andreis, A ; Budano, C ; Levis, M ; Garrone, P ; Usmiani, T ; D’Ascenzo, F ; de Filippo, O ; D’Amico, Maurizio ; Bergamasco, Laura ; Biancone, Luigi ; Marra, Sebastiano ; Colombo, A ; Gaita, F. / Contrast-induced kidney injury: how does it affect long-term cardiac mortality?. In: Journal of Cardiovascular Medicine. 2017 ; Vol. 18, No. 11. pp. 908-915.
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title = "Contrast-induced kidney injury: how does it affect long-term cardiac mortality?",
abstract = "AIMS: Contrast-induced acute kidney injury (CIAKI) is a common complication after coronary angiography or percutaneous revascularization (PCI). This study aimed to investigate the association of CIAKI with long-term cardiovascular adverse events. METHODS: In total, 980 patients undergoing coronary angiography/PCI were assessed in this prospective cohort study. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) and cardiac death (CVD) during an 8-year follow-up. Glomerular filtration rate change during the follow-up was the secondary endpoint.CIAKI was defined as a serum creatinine increase at least 0.3?mg/dl in 48?h or at least 50{\%} in 7 days. RESULTS: CIAKI was observed in 69 patients (7{\%}). Chronic kidney disease [relative risk (RR)?=?4, P? <?0.01], reduced ejection fraction (RR?=?2.88, P? <?0.01), CIAKI risk score at least 4 (RR?=?2.64, P?=?0.02), and emergency coronary angiography/PCI (RR?=?3.87, P? <?0.01) increased CIAKI risk, whereas statins were protective (RR?=?0.32, P? <?0.01).Patients with CIAKI had higher rates of 8-year cardiovascular adverse events: 54 versus 15{\%} MACCE (RR?=?6.67, P? <?0.01), 38 versus 4{\%} CVD (RR?=?15.73, P? <?0.01). Among other factors, CIAKI was the strongest predictor of 8-year MACCE (RR?=?3.16, P? <?0.01) and CVD (RR?=?7.34, P? <?0.01).During the follow-up, glomerular filtration rate declined drastically in CIAKI patients: 70 versus 39{\%} had chronic kidney disease stage worsening (P? <?0.01) and 8 versus 0.3{\%} started hemodialysis (P? <?0.01). CONCLUSION: We found a strong correlation between CIAKI and poor long-term cardiac outcomes. Apparently showing up as a transient, functional impairment of kidney function, CIAKI implies an organic damage with structural modifications leading to significant kidney deterioration over time, responsible for an increased risk of long-term cardiac events. Statins significantly reduced CIAKI occurrence. A careful management of high-risk patients is needed to limit long-term complications of coronary angiography/PCI. {\circledC} 2017 Italian Federation of Cardiology. All rights reserved.",
author = "A Andreis and C Budano and M Levis and P Garrone and T Usmiani and F D’Ascenzo and {de Filippo}, O and Maurizio D’Amico and Laura Bergamasco and Luigi Biancone and Sebastiano Marra and A Colombo and F Gaita",
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T1 - Contrast-induced kidney injury: how does it affect long-term cardiac mortality?

AU - Andreis, A

AU - Budano, C

AU - Levis, M

AU - Garrone, P

AU - Usmiani, T

AU - D’Ascenzo, F

AU - de Filippo, O

AU - D’Amico, Maurizio

AU - Bergamasco, Laura

AU - Biancone, Luigi

AU - Marra, Sebastiano

AU - Colombo, A

AU - Gaita, F

PY - 2017

Y1 - 2017

N2 - AIMS: Contrast-induced acute kidney injury (CIAKI) is a common complication after coronary angiography or percutaneous revascularization (PCI). This study aimed to investigate the association of CIAKI with long-term cardiovascular adverse events. METHODS: In total, 980 patients undergoing coronary angiography/PCI were assessed in this prospective cohort study. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) and cardiac death (CVD) during an 8-year follow-up. Glomerular filtration rate change during the follow-up was the secondary endpoint.CIAKI was defined as a serum creatinine increase at least 0.3?mg/dl in 48?h or at least 50% in 7 days. RESULTS: CIAKI was observed in 69 patients (7%). Chronic kidney disease [relative risk (RR)?=?4, P? <?0.01], reduced ejection fraction (RR?=?2.88, P? <?0.01), CIAKI risk score at least 4 (RR?=?2.64, P?=?0.02), and emergency coronary angiography/PCI (RR?=?3.87, P? <?0.01) increased CIAKI risk, whereas statins were protective (RR?=?0.32, P? <?0.01).Patients with CIAKI had higher rates of 8-year cardiovascular adverse events: 54 versus 15% MACCE (RR?=?6.67, P? <?0.01), 38 versus 4% CVD (RR?=?15.73, P? <?0.01). Among other factors, CIAKI was the strongest predictor of 8-year MACCE (RR?=?3.16, P? <?0.01) and CVD (RR?=?7.34, P? <?0.01).During the follow-up, glomerular filtration rate declined drastically in CIAKI patients: 70 versus 39% had chronic kidney disease stage worsening (P? <?0.01) and 8 versus 0.3% started hemodialysis (P? <?0.01). CONCLUSION: We found a strong correlation between CIAKI and poor long-term cardiac outcomes. Apparently showing up as a transient, functional impairment of kidney function, CIAKI implies an organic damage with structural modifications leading to significant kidney deterioration over time, responsible for an increased risk of long-term cardiac events. Statins significantly reduced CIAKI occurrence. A careful management of high-risk patients is needed to limit long-term complications of coronary angiography/PCI. © 2017 Italian Federation of Cardiology. All rights reserved.

AB - AIMS: Contrast-induced acute kidney injury (CIAKI) is a common complication after coronary angiography or percutaneous revascularization (PCI). This study aimed to investigate the association of CIAKI with long-term cardiovascular adverse events. METHODS: In total, 980 patients undergoing coronary angiography/PCI were assessed in this prospective cohort study. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) and cardiac death (CVD) during an 8-year follow-up. Glomerular filtration rate change during the follow-up was the secondary endpoint.CIAKI was defined as a serum creatinine increase at least 0.3?mg/dl in 48?h or at least 50% in 7 days. RESULTS: CIAKI was observed in 69 patients (7%). Chronic kidney disease [relative risk (RR)?=?4, P? <?0.01], reduced ejection fraction (RR?=?2.88, P? <?0.01), CIAKI risk score at least 4 (RR?=?2.64, P?=?0.02), and emergency coronary angiography/PCI (RR?=?3.87, P? <?0.01) increased CIAKI risk, whereas statins were protective (RR?=?0.32, P? <?0.01).Patients with CIAKI had higher rates of 8-year cardiovascular adverse events: 54 versus 15% MACCE (RR?=?6.67, P? <?0.01), 38 versus 4% CVD (RR?=?15.73, P? <?0.01). Among other factors, CIAKI was the strongest predictor of 8-year MACCE (RR?=?3.16, P? <?0.01) and CVD (RR?=?7.34, P? <?0.01).During the follow-up, glomerular filtration rate declined drastically in CIAKI patients: 70 versus 39% had chronic kidney disease stage worsening (P? <?0.01) and 8 versus 0.3% started hemodialysis (P? <?0.01). CONCLUSION: We found a strong correlation between CIAKI and poor long-term cardiac outcomes. Apparently showing up as a transient, functional impairment of kidney function, CIAKI implies an organic damage with structural modifications leading to significant kidney deterioration over time, responsible for an increased risk of long-term cardiac events. Statins significantly reduced CIAKI occurrence. A careful management of high-risk patients is needed to limit long-term complications of coronary angiography/PCI. © 2017 Italian Federation of Cardiology. All rights reserved.

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DO - 10.2459/JCM.0000000000000543

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SP - 908

EP - 915

JO - Journal of Cardiovascular Medicine

JF - Journal of Cardiovascular Medicine

SN - 1558-2027

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