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Clinical Trial
. 2023 Aug 14;16(15):1873-1886.
doi: 10.1016/j.jcin.2023.06.015.

Validation of a Contemporary Acute Kidney Injury Risk Score in Patients With Acute Coronary Syndrome

Antonio Landi  1 , Mauro Chiarito  2 , Mattia Branca  3 , Enrico Frigoli  4 , Andrea Gagnor  5 , Paolo Calabrò  6 , Carlo Briguori  7 , Giuseppe Andò  8 , Alessandra Repetto  9 , Ugo Limbruno  10 , Paolo Sganzerla  11 , Alessandro Lupi  12 , Bernardo Cortese  13 , Arturo Ausiello  14 , Salvatore Ierna  15 , Giovanni Esposito  16 , Giuseppe Ferrante  17 , Andrea Santarelli  18 , Gennaro Sardella  19 , Ferdinando Varbella  20 , Dik Heg  3 , Roxana Mehran  21 , Marco Valgimigli  22
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Free article
Clinical Trial

Validation of a Contemporary Acute Kidney Injury Risk Score in Patients With Acute Coronary Syndrome

Antonio Landi et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: A simple, contemporary risk score for the prediction of contrast-associated acute kidney injury (CA-AKI) after percutaneous coronary intervention (PCI) was recently updated, although its external validation is lacking.

Objectives: The aim of this study was to validate the updated CA-AKI risk score in a large cohort of acute coronary syndrome patients from the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of angioX) trial.

Methods: The risk score identifies 4 risk categories for CA-AKI. The primary endpoint was to appraise the receiver-operating characteristics of an 8-component and a 12-component CA-AKI model. Independent predictors of Kidney Disease Improving Global Outcomes-based acute kidney injury and the impact of CA-AKI on 1-year mortality and bleeding were also investigated.

Results: The MATRIX trial included 8,201 patients with complete creatinine values and no end-stage renal disease. CA-AKI occurred in 5.5% of the patients, with a stepwise increase of CA-AKI rates from the lowest to the highest of the 4 risk categories. The receiver-operating characteristic area under the curve was 0.67 (95% CI: 0.64-0.70) with model 1 and 0.71 (95% CI: 0.68-0.74) with model 2. CA-AKI risk was systematically overestimated with both models (Hosmer-Lemeshow goodness-of-fit test: P < 0.05). The 1-year risks of all-cause mortality and bleeding were higher in CA-AKI patients (HR: 7.03 [95% CI: 5.47-9.05] and HR: 3.20 [95% CI: 2.56-3.99]; respectively). There was a gradual risk increase for mortality and bleeding as a function of the CA-AKI risk category for both models.

Conclusions: The updated CA-AKI risk score identifies patients at incremental risks of acute kidney injury, bleeding, and mortality. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of angioX [MATRIX]; NCT01433627).

Keywords: acute coronary syndrome; acute kidney injury; percutaneous coronary intervention; risk score.

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Conflict of interest statement

Funding Support and Author Disclosures The trial was sponsored by the Società Italiana di Cardiologia Invasiva (GISE, a nonprofit organization), which received grant support from The Medicines Company and Terumo. This substudy did not receive any direct or indirect funding. Drs Branca and Heg are with CTU Bern, University of Bern, which has a staff policy of not accepting honoraria or consultancy fees. However, CTU Bern is involved in design, conduct, or analysis of clinical studies funded by not-for-profit and for-profit organizations. In particular, pharmaceutical and medical device companies provide direct funding to some of these studies. For an up-to-date list of CTU Bern’s conflicts of interest see http://www.ctu.unibe.ch/research/declaration_of_interest/index_eng.html. Dr Ferrante has received lecture fees from Terumo Italia SRL. Dr Mehran has received institutional research grants from Abbott, Abiomed, Applied Therapeutics, Arena, AstraZeneca, Bayer, Biosensors, Boston Scientific, Bristol Myers Squibb, CardiaWave, CellAegis, CERC, Chiesi, Concept Medical, CSL Behring, DSI, Insel Gruppe AG, Medtronic, Novartis Pharmaceuticals, OrbusNeich, Philips, Transverse Medical, and Zoll; has received personal fees from ACC, Boston Scientific, California Institute for Regenerative Medicine, Cine-Med Research, Janssen, WebMD, and SCAI; has received consulting fees paid to the institution from Abbott, Abiomed, AM-Pharma, Alleviant Medical, Bayer, Beth Israel Deaconess, CardiaWave, CeloNova, Chiesi, Concept Medical, DSI, Duke University, Idorsia Pharmaceuticals, Medtronic, Novartis, and Philips; has equity (1%) in Applied Therapeutics, Elixir Medical, STEL, and CONTROLRAD (spouse); and is on the Scientific Advisory Board for AMA and Biosensors (spouse) all outside the submitted work. Dr Valgimigli has received grants and personal fees from Abbott, Terumo, and AstraZeneca; has received personal fees from Chiesi, Bayer, Daiichi Sankyo, and Amgen, Biosensors, and Idorsia; and had received grants from Medicure. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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