Contrast-induced acute kidney injury and adverse clinical outcomes risk in acute coronary syndrome patients undergoing percutaneous coronary intervention: a meta-analysis

Abstract

Background: Recent studies have shown associations between contrast-induced acute kidney injury (CI-AKI) and increased risk of adverse clinical outcomes in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI); however, the estimates are inconsistent and vary widely. Therefore, this meta-analysis aimed to evaluate the precise associations between CI-AKI and adverse clinical consequences in patients undergoing PCI for ACS.

Methods: EMBASE, PubMed, Web of Science™ and Cochrane Library databases were systematically searched from inception to December 16, 2016 for cohort studies assessing the association between CI-AKI and any adverse clinical outcomes in ACS patients treated with PCI. The results were demonstrated as pooled risk ratios (RRs) with 95% confidence intervals (CI). Heterogeneity was explored by subgroup analyses.

Results: We identified 1857 articles in electronic search, of which 22 (n = 32,781) were included. Our meta-analysis revealed that in ACS patients undergoing PCI, CI-AKI significantly increased the risk of adverse clinical outcomes including all-cause mortality (18 studies; n = 28,367; RR = 3.16, 95% CI 2.52-3.97; I² = 56.9%), short-term all-cause mortality (9 studies; n = 13,895; RR = 5.55, 95% CI 3.53-8.73; I² = 60.1%), major adverse cardiac events (7 studies; n = 19,841; RR = 1.49, 95% CI: 1.34-1.65; I² = 0), major adverse cardiovascular and cerebrovascular events (3 studies; n = 2768; RR = 1.86, 95% CI: 1.42-2.43; I² = 0) and stent restenosis (3 studies; n = 130,678; RR = 1.50, 95% CI: 1.24-1.81; I² = 0), respectively. Subgroup analyses revealed that the studies with prospective cohort design, larger sample size and lower prevalence of CI-AKI might have higher short-term all-cause mortality risk.

Conclusions: CI-AKI may be a prognostic marker of adverse outcomes in ACS patients undergoing PCI. More attention should be paid to the diagnosis and management of CI-AKI.

Keywords: Acute Coronary syndrome; Contrast-induced acute kidney injury; Meta-analysis; Percutaneous Coronary intervention; Risk.

Fig. 1

Flow chart of the systematic review. Abbreviations: CI-AKI, contrast-induced acute kidney injury.

Fig. 2

Assessment of study quality

Fig. 3

Association between contrast-induced acute kidney injury (CI-AKI) and risk of adverse clinical outcomes. a all-cause mortality, (b) short-term all-cause mortality, (c) major adverse cardiac events (MACE), (d) major adverse cardiovascular and cerebrovascular events (MACCE) and (e) stent restenosis. Abbreviations: RR, risk ratio

Fig. 4

Subgroup and meta-regression analysis for all-cause mortality and short-term all-cause mortality. Abbreviations: RR, risk ratio; PC, prospective; RC, retrospective; CI-AKI, CI-AKI, contrast-induced acute kidney injury; HT, hypertension; DM, diabetes mellitus; HLP, hyperlipidemia; PCI, percutaneous coronary intervention. Hint: the cut points for all-cause mortality: sample size, 1500; mean age, 62 years old; prevalence of CI-AKI, 14.5%; prevalence of HT, 55%; prevalence of DM, 24.2%; prevalence of HLP, 48%; prevalence of smoker, 47.5% and for short-term all-cause mortality: sample size, 2000; mean age, 60 years old; prevalence of CI-AKI, 13.6%; prevalence of HT, 53%; prevalence of DM, 23.4%. The cut-off points are all the means for continuous data.