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Periprocedural bleeding linked to contrast-induced kidney injury
PCI-related periprocedural bleeding was significantly associated with contrast-induced acute kidney injury, with the incidence correlating with bleeding severity, study results found.
In the study, researchers evaluated the association between contrast-induced acute kidney injury (CI-AKI), defined as an increase in serum creatinine level of at least 0.5 mg/dL or at least 25% above baseline values at 48 hours after administration of contrast media. They performed a retrospective analysis of a prospectively maintained multicenter registry, which included 2,646 consecutive patients who were divided into five groups according to the decrease of hemoglobin level after PCI. The five levels were: patients without hemoglobin level decrease (group A); decreased hemoglobin level <1 g/dL (group B); 1 g/dL to <2g/dL (group C); 2 g/dL to <3 g/dL (group D); and >3 g/dL (group E).
Overall, 315 (11.9%) developed CI-AKI. The incidence was 6.2% in group A, 7.5% in group B, 10.7% in group C, 17% in group D and 26.2% in group E (P<.01). The incidence of major bleeding was 0.7% in group A, 1.3% in group B, 2% in group C, 4.1% in group D and 28.3% in group E (P<.01).
In concordance with previous studies, researchers also noted that CI-AKI was associated with higher rates of in-hospital mortality (5.4% vs. 0.6%; P<.01) and the composite of postprocedural HF, cardiogenic shock and death (16.5% vs. 2.8%; P<.01).
“In most cath labs, baseline creatinine is currently assessed before PCI, therefore, interventional cardiologists can predict the risk of developing CI-AKI before the procedure especially in elective cases,” they wrote. “Those patients predicted at high risk for CI-AKI should undergo additional preventive measures, staged procedures, and perioperative blood loss should be minimized. In such cases, performing PCI via transradial approach may also be preferred, since the risk of bleeding is significantly lower compared with the transfemoral approach.”
Disclosure: The researchers report no relevant financial disclosures.