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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    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