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. 2025 Jul;4(7):101899.
doi: 10.1016/j.jacadv.2025.101899.

Risk-Stratified Prognostic Implications of Contrast-Associated Acute Kidney Injury After Percutaneous Coronary Intervention

Takahiro Suzuki  1 , Shun Kohsaka  2 , John A Spertus  3 , Satoshi Shoji  4 , Yasuyuki Shiraishi  5 , Nobuhiro Ikemura  6 , Ryo Nakamaru  5 , Takanori Ohata  5 , Masaki Kodaira  5 , Ikuko Ueda  5 , Shigetaka Noma  7 , Yohei Numasawa  5 , Masaki Ieda  5
Affiliations

Risk-Stratified Prognostic Implications of Contrast-Associated Acute Kidney Injury After Percutaneous Coronary Intervention

Takahiro Suzuki et al. JACC Adv. 2025 Jul.

Abstract

Background: The clinical importance of contrast-associated acute kidney injury (CA-AKI), the most common complication after percutaneous coronary intervention (PCI), is debated.

Objectives: We aimed to assess the association between CA-AKI and long-term outcomes, overall and across the National Cardiovascular Data Registry (NCDR) AKI risk categories.

Methods: We analyzed patients undergoing PCI between September 2008 and October 2021 from a Japanese registry aligned with the NCDR and categorized them by the NCDR AKI risk score tertiles (low-risk [<4.9%], intermediate-risk [4.9%-6.7%], and high-risk [≥6.7%]) groups. CA-AKI was defined as a 0.3 mg/dL increase or 50% increase in creatinine or the initiation of dialysis. Cox regression analyses assessed the association between CA-AKI and 2-year major adverse cardiovascular events (MACE; all-cause mortality, acute coronary syndrome, heart failure hospitalization, or stroke), and interactions were tested to examine whether preprocedural risk modified the association of CA-AKI with outcomes.

Results: Of 7,916 patients, 723 (9.1%) developed CA-AKI; its incidence for low-risk, intermediate-risk, and high-risk groups was 2.3%, 7.3%, and 17.9%, respectively. CA-AKI was associated with an increased risk of MACE (adjusted HR [aHR]: 1.64; 95% CI: 1.37-1.97). The interaction between AKI risk profile and MACE was not significant (P interaction = 0.14), and a consistent association of CA-AKI and MACE across risk categories was observed (high-risk, aHR: 1.60; 95% CI: 1.30-1.98; intermediate, aHR: 1.64; 95% CI: 1.10-2.44; and low, aHR: 2.84; 95% CI: 1.43-5.65, respectively).

Conclusions: CA-AKI was associated with long-term outcomes across all AKI risk profiles in PCI patients, underscoring the importance of interventions to reduce periprocedural CA-AKI.

Keywords: contrast-associated acute kidney injury; major adverse cardiovascular events; percutaneous coronary intervention; preprocedural risk score.

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Conflict of interest statement

Funding support and author disclosures This research was supported by a grant from the Ministry of Education, Culture, Sports, Science, and Technology, Japan (KAKENHI No. 20H03915). Dr Kohsaka has received speaker fees from Pfizer and has received institutional research grant support from AstraZeneca. The funders did not play a role in the study design, data collection, data analysis, publication decision, or manuscript preparation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Flow Chart of the Study Study population and eligibility criteria are shown. AKI = acute kidney injury; JCD-KiCS = Japan Cardiovascular Database-Keio Inter-Hospital Cardiovascular Studies; NCDR = National Cardiovascular Data Registry; PCI = percutaneous coronary intervention.
Figure 2
Figure 2
Kaplan-Meier Survival Estimates for MACE for All Patients and Stratified by CA-AKI Risk Groups (A) Across the entire cohort, patients with CA-AKI had significantly higher incidence rates of MACE. (B and C) In the high- and intermediate-risk groups, patients with CA-AKI demonstrated significantly higher rates of MACE compared to patients without CA-AKI. (D) Within the low-risk group, no statistically significant difference was observed in long-term MACE. CA-AKI = contrast-associated acute kidney injury; MACE = major adverse cardiovascular events.
Figure 2
Figure 2
Kaplan-Meier Survival Estimates for MACE for All Patients and Stratified by CA-AKI Risk Groups (A) Across the entire cohort, patients with CA-AKI had significantly higher incidence rates of MACE. (B and C) In the high- and intermediate-risk groups, patients with CA-AKI demonstrated significantly higher rates of MACE compared to patients without CA-AKI. (D) Within the low-risk group, no statistically significant difference was observed in long-term MACE. CA-AKI = contrast-associated acute kidney injury; MACE = major adverse cardiovascular events.
Central Illustration
Central Illustration
Study Design and Main Results aHR = adjusted HR; other abbreviations as in Figures 1 and 2.
See this image and copyright information in PMC

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