New score clarifies risk for contrast-induced acute kidney injury in PCI
Click Here to Manage Email Alerts
A risk score based on 8 years of data showed excellent prediction of risk for contrast-induced acute kidney injury in patients undergoing PCI, researchers reported at the American Heart Association Scientific Sessions.
The Mehran 2 CA-AKI risk score was devised based on patients who had PCI at Mount Sinai Hospital from 2012 to 2020, had available creatinine measurements before and within 48 hours after their procedure and were not on chronic dialysis. The findings were simultaneously published in The Lancet.
“The last time we had a risk score [for contrast-induced acute kidney injury in PCI] was in 2004,” Roxana Mehran, MD, professor of medicine and director of interventional cardiology research at the Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai, told Healio. “We felt that it was time to revisit that, with all of the incredible enhancements that have been done in terms of contrast-associated kidney injury in PCI; we felt for sure it needed to be recalibrated.”
Independent predictors of contrast-induced acute kidney injury included in model 1 of the risk score, which consisted only of preprocedural variables, were clinical presentation, estimated glomerular filtration rate, left ventricular ejection fraction, diabetes, hemoglobin, basal glucose, HF and age. Additional independent predictors included in model 2 of the score, which also consisted of procedural variables, were contrast volume, periprocedural bleeding, no flow or slow flow after the procedure and complex PCI anatomy.
The derivation cohort included 14,616 patients who had PCI from 2012 to 2017 (mean age, 66 years; 29% women), whereas the validation cohort included 5,606 patients who had PCI from 2018 to 2020 (mean age, 67 years; 26% women). Patients were stratified into quartiles by risk score in both models.
During the study period, contrast-induced acute kidney injury occurred in 4.3% of patients, which Mehran said is a lower rate than existed in 2004.
In the derivation cohort, in both models, incidence of contrast-induced acute kidney injury increased with higher risk score (model 1: lowest quartile, 2.3%; highest quartile, 34.9%; model 2: lowest quartile, 2%; highest quartile, 38.8%), according to the researchers.
The C-statistic in the derivation cohort was 0.72 for model 1 and 0.74 for model 2, whereas in the validation cohort it was 0.84 for model 1 and 0.86 for model 2, Mehran and colleagues found. The 2004 risk score had a C-statistic of 0.68.
Patients with contrast-induced acute kidney injury had a 76% increased risk for 1-year mortality compared with patients who did not have it (10.2% vs. 2.5%; adjusted HR = 1.76; 95% CI, 1.31-2.36; P = .0002), according to the researchers.
“We came up with two models, one which you can evaluate before the procedure ... and then we added to that some of the periprocedural variables,” Mehran told Healio. “The addition of the periprocedural parameters added only a little bit of better scrutiny, but most importantly, contrast-induced acute kidney injury was associated with 1-year mortality, most of which was in the first 30 days. This is a new way for us to rethink the issue. Our future work is to externally validate the score.”
Reference:
Collapse
Mehran R, et al. FS.06. Improving Interventions for Vascular Disease. Presented at: American Heart Association Scientific Sessions; Nov. 13-15, 2021 (virtual meeting).
Click Here to Manage Email Alerts