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Abstract
Background Acute kidney injury (AKI) is a recognised complication of percutaneous coronary intervention (PCI). We investigated the predictors, aetiology and long-term outcome of AKI following PCI for acute coronary syndromes (ACS).
Methods Two thousand nine-hundred and seventeen patients undergoing PCI for ACS were retrospectively investigated. AKI incidence was identified and cardiovascular and demographic risk factors, and dates of death were collected.
Results After exclusion, 198 patients (7.2% undergoing PCI) had an AKI: 14.1% of these AKI patients presented in cardiogenic shock, whilst 5.1% of patients had an elevated ESR and/or eosinophil count and were classified as atheroembolic renal disease (AERD). Statistically significant risk factors for developing AKI were increased age (OR 1.04, 95% Cl 1.03 to 1.06, p<0.0001), diabetes (OR 1.56, 95% Cl 1.09 to 2.21, p=0.0129), heart failure (OR 2.30, 95% Cl 1.22 to 4.15, p=0.0073), femoral access (OR 1.47, 95% Cl 1.02 to 2.10, p=0.0357) and cardiogenic shock on arrival (OR 2.92, 95% Cl 1.72 to 4.81, p<0.0001). Significant association with mortality at 1-year was found in patients with an AKI (OR 4.33, 95% Cl 2.89 to 6.43, p<0.0001), age (OR 1.08, 95% Cl 1.06 to 1.09, p<0.0001), heart failure (OR 1.92, 95% Cl 1.05 to 3.44, p=0.032), femoral access (OR 2.05, 95% Cl 1.41 to 2.95, p=0.0001), and cardiogenic shock (OR 3.63, 95% Cl 2.26 to 5.77, p<0.0001). Analysis of survival demonstrated a hazard ratio of mortality of 4.23 in the AKI group when compared to non-AKI patients (95% Cl 3.00 to 5.98, p<0.0001) (see figure 1). Significant associations with 1-year mortality in AKI patients were age (OR 1.04, 95% Cl 1.01 to 1.07, p=0.011), and cardiogenic shock (OR 4.40, 95% Cl 1.56 to 10.90, p=0.004). Patients with AERD AKI had a 1-year mortality rate of 40.0% and a 1-year renal replacement therapy requirement of 22.2%. This was compared to a 1-year mortality rate of 33.8% in AKI patients of any aetiology, and a renal replacement therapy requirement of 8.0%.
Conclusion AKI after urgent PCI is strongly associated with worse outcome. Risk factors for developing AKI were age, diabetes, heart failure, femoral access and cardiogenic shock. Risk of mortality at 1-year were the development of AKI, age, femoral access and cardiogenic shock. AERD occurred in 5.1% of those who develop an AKI and is an often-overlooked condition with poor outcome and likelihood of long-term renal replacement requirement. Early identification of patients is important to provide appropriate supportive care.
Conflict of Interest None