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Multicenter Study
. 2022 Apr 11;15(7):753-766.
doi: 10.1016/j.jcin.2021.11.026. Epub 2022 Mar 16.

Long-Term Clinical Impact of Contrast-Associated Acute Kidney Injury Following PCI: An ADAPT-DES Substudy

Reza Mohebi  1 , Keyvan Karimi Galougahi  2 , Javier Jas Garcia  2 , Jennifer Horst  2 , Ori Ben-Yehuda  2 , Jai Radhakrishnan  3 , Glenn M Chertow  4 , Allen Jeremias  5 , David J Cohen  5 , David J Cohen  3 , Akiko Maehara  6 , Gary S Mintz  2 , Shmuel Chen  6 , Björn Redfors  7 , Martin B Leon  6 , Thomas D Stuckey  8 , Michael J Rinaldi  9 , Giora Weisz  10 , Bernhard Witzenbichler  11 , Ajay J Kirtane  6 , Roxana Mehran  1 , George D Dangas  1 , Gregg W Stone  1 , Ziad A Ali  12
Affiliations
Free article
Multicenter Study

Long-Term Clinical Impact of Contrast-Associated Acute Kidney Injury Following PCI: An ADAPT-DES Substudy

Reza Mohebi et al. JACC Cardiovasc Interv. .
Free article

Abstract

Objectives: This study sought to determine correlates and consequences of contrast-associated acute kidney injury (CA-AKI) on clinical outcomes in patients with or without pre-existing chronic kidney disease (CKD).

Background: The incidence and impact of CA-AKI on clinical outcomes during contemporary percutaneous coronary intervention (PCI) are not fully defined.

Methods: The ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents) study was a prospective, multicenter registry of 8,582 patients treated with ≥1 drug-eluting stent(s). CA-AKI was defined as a post-PCI increase in serum creatinine of >0.5 mg/dL or a relative increase of ≥25% compared with pre-PCI. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2. The primary endpoint was the 2-year rate of net adverse clinical events (NACE): All-cause mortality, myocardial infarction (MI), definite or probable stent thrombosis, or major bleeding.

Results: Of 7287 (85%) patients with evaluable data, 476 (6.5%) developed CA-AKI. In a multivariable model, older age, female sex, Caucasian race, congestive heart failure, diabetes, hypertension, CKD, presentation with ST-segment elevation MI, Killip class II to IV, radial access, intra-aortic balloon pump use, hypotension, and number of stents were independent predictors of CA-AKI. The 2-year NACE rate was higher in patients with CA-AKI (adjusted HR: 1.88; 95% CI: 1.42-2.49), as was each component of NACE (all-cause mortality, HR: 1.77; 95% CI: 1.22-2.55; MI, HR: 1.67; 95% CI: 1.18-2.36; definite/probable stent thrombosis, HR: 1.71; 95% CI: 1.10-2.65; and major bleeding, HR: 1.38; 95% CI: 1.06-1.80). Compared with the CA-AKI-/CKD- group, the CA-AKI+/CKD- (HR: 1.83; 95% CI: 1.33-2.52), CA-AKI-/CKD+ (HR: 1.56; 95% CI: 1.15-2.13), CA-AKI+/CKD+ (HR: 3.29; 95% CI: 1.92-5.67), and maintenance dialysis (HR: 2.67; 95% CI: 1.65-4.31) groups were at higher risk of NACE.

Conclusions: CA-AKI was relatively common after contemporary PCI and was associated with increased 2-year rates of NACE. Patients with pre-existing CKD were at particularly high risk for NACE after CA-AKI.

Keywords: chronic kidney disease; contrast-associated nephropathy; percutaneous coronary intervention.

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Conflict of interest statement

Funding Support and Author Disclosures The ADAPT-DES study was sponsored by the Cardiovascular Research Foundation, with funding provided by Boston Scientific, Abbott Vascular, Medtronic, Cordis, Biosensors, The Medicines Company, Daiichi Sankyo, Eli Lilly, Volcano, and Accumetrics. Dr Chertow has received grant funding from the National Institute of Diabetes and Digestive and Kidney Diseases and National Institute of Allergy and Infectious Diseases; served as a consultant to Akebia, Ardelyx, AstraZeneca, Baxter, CloudCath, Cricket, Durect, Gilead, Miromatrix, Outset, Reata, Sanifit, Unicycive, and Vertex; and served on the Data Safety and Monitoring Board/Data Monitoring Committee for Angion, Bayer, National Institute of Diabetes and Digestive and Kidney Diseases, and ReCor. Dr Jeremias has received institutional funding (unrestricted education grant) and served as a consultant for Volcano/Philips and Abbott Vascular; and served as consultant to ACIST Medical and Boston Scientific. Dr Cohen has received research grant support and consulting income from Abbott, Medtronic, Edwards Lifesciences, and Boston Scientific. Dr Maehara has received grant support and served as a consultant for Abbott Vascular and Boston Scientific. Dr Mintz has received honoraria from Abiomed, Boston Scientific, Medtronic, and Philips. Dr Leon has received institutional research grants and served as a nonpaid advisor for Abbott, Boston Scientific, and Medtronic; and has served as a nonpaid advisor for Sinomed; and owns equity in Medinol. Dr Stuckey has served on the advisory board for Boston Scientific; and received speaker honoraria from Boston Scientific and Eli Lilly/Daiichi Sankyo. Dr Rinaldi has served on the advisory board for Boston Scientific; has taught courses for Abbott and Edwards Lifesciences; served as a consultant for Abbott, Boston Scientific, and Edwards Lifesciences; received research/grant support from Boston Scientific; and served as a proctor for Abbott and Edwards Lifesciences. Dr Weisz has received consulting fees from Filterlex, Intratech, and Magenta; and owns stock options in Filterlex, Intratech, Magenta, Medivizer, Trisol, and Vectorious. Dr Kirtane has received institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, and ReCor Medical, and in addition to research grants, institutional funding includes fees paid to Columbia University and/or Cardiovascular Research Foundation for speaking engagements and/or consulting; served as a consultant for Neurotronic; and received travel expenses/meals from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, ReCor Medical, Chiesi, OpSens, Zoll, and Regeneron. Dr Mehran has received institutional research grants from Abbott Laboratories, AstraZeneca, Bayer, Beth Israel Deaconess, Bristol Myers Squibb, CERC, Chiesi, Concept Medical, CSL Behring, DSI, Medtronic, Novartis Pharmaceuticals, and OrbusNeich; has received consultant fees from Abbott Laboratories, Boston Scientific, Janssen Scientific Affairs, Medscape/WebMD, Medtelligence (Janssen Scientific Affairs), Roivant Sciences, Sanofi, and Siemens Medical Solutions; has received consultant fees paid to the institution from Abbott Laboratories, Bristol Myers Squibb; has served on the advisory board for, with funding paid to the institution from Spectranetics/Philips/Volcano; has a spouse who has served as a consultant for Abiomed and The Medicines Company; owns equity <1% in Claret Medical, Elixir Medical; has received on the Data Safety and Monitoring Board Membership fees paid to the institution from Watermark Research Partners; has served as a consultant (no fee) for Idorsia Pharmaceuticals and Regeneron Pharmaceuticals; and has served as an Associate Editor for the American College of Cardiology and the American Medical Association. Dr Dangas has received research grant support from the The Medicines Company, Bristol Myers Squibb/Sanofi, and Eli Lilly and Company/Daiichi Sankyo; and served as a consultant for Abbott Vascular, AstraZeneca, Boston Scientific, Covidien, Janssen Pharmaceuticals, Regado Biosciences, Maya Medical, Merck and Co, and The Medicines Company. Dr Stone has received speaker and other honoraria from Cook, Terumo, Orchestra Biomed, and Qool Therapeutics; has served as a consultant to TherOx, Reva, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Matrizyme, Miracor, Neovasc, V-Wave, Abiomed, Shockwave, MAIA Pharmaceuticals, Cardiomech, SpectraWave, Valfix, Ancora, and Vectorious; and owns equity/options in Applied Therapeutics, Biostar family of funds, MedFocus family of funds, Aria, Cardiac Success, Cagent, SpectraWave, Valfix, Ancora, Orchestra Biomed, and Qool Therapeutics. Dr Ali has received institutional research grants from Abbott, Boston Scientific, Philips, Opsens Medical, Abiomed, ACIST Medical, Medtronic, and Cardiovascular Systems Inc; has served as a consultant for Amgen, AstraZeneca, and Boston Scientific; and owns equity in Shockwave. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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