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.
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, 18(11), 908-915. https://doi.org/10.2459/JCM.0000000000000543