Objectives Contrast-induced acute kidney injury (CI-AKI) is a common and potentially severe complication in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). There is no consensus on the best definition of CI-AKI to identify patients at risk of haemodialysis or death. The objective of this study was to assess the association of CI-AKI, using four definitions, on inhospital mortality, mortality or haemodialysis requirement over 1-year follow-up, in patients with STEMI treated with pPCI.
Methods In this prospective, observational study, all patients with STEMI referred for pPCI were included. We identified independent variables associated with CI-AKI and mortality.
Results We included 1114 consecutive patients with STEMI treated by pPCI. CI-AKI occurred in 18.3%, 12.2%, 15.6% and 10.5% of patients according to the CIN, Acute Kidney Injury Network (AKIN), Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) Modification of Diet in Renal Disease (MDRD) and RIFLE Chronic Kidney Disease - Epidemiology Collaboration (CKD-EPI) definitions, respectively. The RIFLE (CKD-EPI) definition was the most discriminant definition to identify patients at higher risk of inhospital mortality (27.1% vs 4.0%; adjusted OR 2.7 (95% CI 1.4 to 5.1), p=0.003), 1-year mortality (27.4% vs 6.6%; adjusted OR 2.8 (95% CI 1.5 to 5.3), p=0.002) and haemodialysis requirement at 1-year follow-up (15.6% vs 2.7%; adjusted OR 6.7 (95% CI 3.3 to 13.6), p=0.001). Haemodynamic instability, cardiac arrest, preexisting renal failure, elderly age and a high contrast media volume were independently associated with 1-year mortality. Of interest, contrast-media volume was not correlated to increase of creatininaemia (r=0.06) or decrease in estimated glomerular filtration rate (r=0.05) after percutaneous coronary intervention in our population.
Conclusions CI-AKI is a frequent and serious complication of STEMI treated by pPCI. The RIFLE definition is the most accurate definition to identify patients with CI-AKI at high risk of mortality or haemodialysis.
- acute myocardial infarction
- acute coronary syndromes
- percutaneous coronary intervention
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Contributors The first author (JS) designed the study, drafted and submitted the manuscript. The first three authors (JS, LSN and VS) contributed to the data analysis and interpretation and the drafting of the paper. All authors participated to the gathering of the data and contributed to critical revision of the manuscript.
Funding Internal funding only (Action Coeur study Group www.action-coeur.org).
Competing interests JS has received research grants, honorarium or travel support from Actelion, Amed, Amgen, Algorythm, Astra-Zeneca, Bayer, Daiichi-Sankyo, Eli Lilly, Fondation de France, Gilead Science, IrokoCardio, Sanofi-Aventis and Saint-Jude Medical. LSN has received research grants from Fédération Française de Cardiologie and Société Française de Cardiologie. MK has received research grants from Sanofi, Fédération Française de Cardiologie, Société Française de Cardiologie, and lectures and consulting fees for ESC, AstraZeneca, Daiichi-Sankyo and Bayer. PG has received research grants from Fédération Française de Cardiologie. GH has received research grants or honorarium from Fédération Française de Cardiologie, Cordis, Boston, Medtronic, Terumo, Biotronik, AstraZeneca, Boehringer Ingelheim, Bayer, Bristol-Myer Squibb and Sanofi-Aventis. JPC has received research grants or honorarium from AstraZeneca, Bayer, Bristol-Myers Squibb, Daiichi-Sankyo, Eli-Lilly, Fédération Française de Cardiologie, Lead-Up, Medtronic, MSD, Sanofi-Aventis and WebMD. GM has received research grants or honorarium from ADIR, Amgen, AstraZeneca, Bayer, Berlin Chimie AG, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women’s Hospital, Cardiovascular Research Foundation, Celladon, CME Resources, Daiichi-Sankyo, Eli-Lilly, Europa, Elsevier, Fédération Française de Cardiologie, Fondazione Anna Maria Sechi per il Cuore, Gilead, ICAN, Janssen, Lead-Up, Menarini, Medtronic, MSD, Pfizer, Sanofi-Aventis, Servier, The Medicines Company, TIMI Study Group and WebMD. Other authors have no conflicts of interest to declare.
Ethics approval The STEMI Registry (e-PARIs) is a declared registry which that was approved by the local scientific ethical committee of the University Hospital Pitié-Salpêtrière (CPP) of Paris.
Provenance and peer review Not commissioned; externally peer reviewed.