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. 2021 May 16;10(10):2151.
doi: 10.3390/jcm10102151.

Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

Rita Pavasini  1 , Matteo Tebaldi  1 , Giulia Bugani  2 , Elisabetta Tonet  1 , Roberta Campana  1 , Paolo Cimaglia  3 , Elisa Maietti  4   5 , Giovanni Grazzi  6 , Graziella Pompei  1 , Gioele Fabbri  1 , Alessio Fiorio  1 , Andrea Rubboli  7 , Gianni Mazzoni  8 , Francesco Vitali  1 , Matteo Serenelli  1 , Gianluca Campo  1   3 , Simone Biscaglia  1
Affiliations

Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

Rita Pavasini et al. J Clin Med. .

Abstract

Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent coronary angiography. The occurrence of CA-AKI was defined based on KDIGO criteria. The primary outcome of the study was to test the relation between CA-AKI and 3-month mortality. Overall, 870 older ACS adults were included in the analysis (mean age 78 ± 5 years; 28% females). CA-AKI occurred in 136 (16%) patients. At 3 months, 13 (9.6%) patients with CA-AKI died as compared with 13 (1.8%) without it (p < 0.001). At multivariable analysis, CA-AKI emerged as independent predictor of 3-month mortality (HR 3.51, 95%CI 1.05-7.01). After 3 months, renal function returned to the baseline value in 78 (63%) with CA-AKI. Those without recovered renal function (n = 45, 37%) showed an increased risk of mortality as compared to recovered renal function and no CA-AKI subgroups (HR 2.01, 95%CI 1.55-2.59, p = 0.009 and HR 2.71, 95%CI 1.45-5.89, p < 0.001, respectively). In conclusion, CA-AKI occurs in a not negligible portion of older MI patients undergoing invasive strategy and it is associated with short-term mortality.

Keywords: acute coronary syndrome; contrast induced acute kidney injury; mortality; older patients; percutaneous coronary intervention; physical performance.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cumulative occurrence of mortality (landmark analysis). Landmark analysis at 3 months. Continue blue line: no CA-AKI. Continue black line: CA-AKI. After the 3-month time point CA-AKI patients are stratified in those who recovered baseline renal function (dotted black line) vs. those who not recovered baseline renal function (pointed black line). CA-AKI: contrast associated acute kidney injury.
See this image and copyright information in PMC

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