Evidence-to-practice gap for preventing procedure-related acute kidney injury in patients undergoing percutaneous coronary intervention

Satoshi Shoji, Mitsuaki Sawano, Alexander T. Sandhu, Paul A. Heidenreich, Yasuyuki Shiraishi, Shigetaka Noma, Masahiro Suzuki, Yohei Numasawa, Keiichi Fukuda, Shun Kohsaka

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

BACKGROUND: Acute kidney injury (AKI) is a common complication of percutaneous coronary intervention. This risk can be minimized with reduction of contrast volume via preprocedural risk assessment. We aimed to identify quality gaps for implementing the available risk scores introduced to facilitate more judicious use of contrast volume. METHODS AND RESULTS: We grouped 14 702 patients who underwent percutaneous coronary intervention according to the calculated NCDR (National Cardiovascular Data Registry) AKI risk score quartiles (Q1 [lowest]–Q4 [highest]). We compared the used contrast volume by the baseline renal function and NCDR AKI risk score quartiles. Factors associated with increased contrast volume usage were determined using multivariable linear regression analysis. The overall incidence of AKI was 8.9%. The used contrast volume decreased in relation to the stages of chronic kidney disease (168 mL [SD, 73.8 mL], 161 mL [SD, 75.0 mL], 140 mL [SD, 70.0 mL], and 120 mL [SD, 73.7 mL] for no, mild, moderate, and severe chronic kidney disease, respectively; P<0.001), albeit no significant correlation was observed with the calculated NCDR AKI risk quartiles. Of the variables included in the NCDR AKI risk score, anemia (7.31 mL [1.76–12.9 mL], P=0.01), heart failure on admission (10.2 mL [6.05–14.3 mL], P<0.001), acute coronary syndrome presentation (10.3 mL [7.87–12.7 mL], P<0.001), and use of an intra-aortic balloon pump (17.7 mL [3.9–31.5 mL], P=0.012) were associated with increased contrast volume. CONCLUSIONS: The contrast volume was largely determined according to the baseline renal function, not the patients’ overall AKI risk. These findings highlight the importance of comprehensive risk assessment to minimize the contrast volume used in susceptible patients.

Original languageEnglish
Article numbere020047
JournalJournal of the American Heart Association
Volume10
Issue number15
DOIs
Publication statusPublished - 2021

Keywords

  • Acute kidney injury
  • Acute kidney injury risk score
  • Contrast volume
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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