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.