Impact of Periprocedural Bleeding on Incidence of Contrast-Induced Acute Kidney Injury in Patients Treated With Percutaneous Coronary Intervention

A cute kidney injury (AKI) is one of the most common adverse events after percutaneous coronary intervention (PCI) and is of prognostic significance.1,2 Risk factors for its development have been the focus of multiple studies, and several patient-related and procedure-related factors have been identified. 3,4 However, no prior studies have considered the risks of periprocedural blood transfusion.There are many pathophysiological mechanisms by which blood transfusion might cause AKI, which are mainly related to impaired tissue oxygen delivery, and inflammation and oxidative stress. 5 Recently, blood transfusion has been identified as a risk factor for AKI in cardiac surgery 5,6 and in transcatheter aortic valve replacement. 7 Patients undergoing PCI are prone to bleeding given the invasive nature of the procedure and the use of antithrombotic and antiplatelet agents. Transfusion is relatively commonly used in these patients, and there is considerable variation in blood transfusion practices among patients undergoing PCI at the US hospitals. 8 The appropriate use of transfusion in this patient population might be influenced by its effect on AKI.Anemia is well-recognized as a risk factor for AKI, 9 and recently periprocedural bleeding in PCI patients was also identified to be associated with AKI. 10 However, the relationship between anemia, bleeding, and transfusion and the risk of AKI has not been well studied. Further characterization of this relationship and definition of other risk factors might help broaden prophylactic strategies against post-PCI AKI.In this cohort of patients with acute coronary syndrome (ACS) who underwent PCI, we aimed to (1) assess the association of blood transfusion with AKI and (2) characterize this relationship with anemia and bleeding. MethodsThe National Cardiovascular Data Registry (NCDR)-CathPCI Registry is the largest ongoing registry of PCI in the United States, Background-Acute kidney injury (AKI) complicating percutaneous coronary intervention (PCI) is associated with adverse clinical outcomes. To date, no studies have evaluated the association of blood transfusion with AKI in patients undergoing PCI. Methods and Results-We used a retrospective cohort study of all patients with acute coronary syndrome undergoing PCI from CathPCI Registry (n=1 756 864). The primary outcome was AKI defined as the rise in serum creatinine post procedure ≥0.5 mg/dL or ≥25% above baseline values. AKI developed in 9.0% of study sample. Patients with AKI were older, more often women, and had high prevalence of comorbidities, including diabetes mellitus, hypertension, and advanced stages of chronic kidney disease at baseline. Blood transfusion was utilized in 2.2% of patients. In the overall sample, AKI developed in 35.1% of patients who received transfusion versus 8.4% of patients without transfusion (adjusted odds ratio, 4.87 [4.71-5.04]). In the subgroup of patients who sustained bleeding event and received transfusion, the rate of AKI was significantly increased across all preprocedure hemoglobin...

Section: Discussionsupporting

confidence: 75%

“…10 However, the relationship between anemia, bleeding, and transfusion and the risk of AKI has not been well studied. Further characterization of this relationship and definition of other risk factors might help broaden prophylactic strategies against post-PCI AKI.…”

mentioning

confidence: 99%

Blood Transfusion and the Risk of Acute Kidney Injury Among Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Karrowni

Vora

Dai

et al. 2016

“…Recently, a strong association between bleeding and AKI was demonstrated in patients undergoing PCI. 16 Although we were able to corroborate this finding, the observed reduction in bleeding with TRI did not seem to mediate the reduction in AKI observed in our study.…”

Section: Discussioncontrasting

confidence: 45%

“…16 Second, the risk of cholesterol embolization to the kidney may be minimized by avoiding catheterization of the descending aorta. It is possible that, by these mechanisms, the risk of AKI might be lower in patients undergoing TRI compared with transfemoral PCI (TFI).…”

mentioning

confidence: 99%

Risk of Acute Kidney Injury After Percutaneous Coronary Interventions Using Radial Versus Femoral Vascular Access

Kooiman

Seth

Dixon

et al. 2014

“…First, AKI is frequently complicated by altered immune function, increased propensity to infection, bleeding, and thrombosis. 25,26 Second, AKI can result in acute volume overload, acidemia, and hyperkalemia contributing to increased cardiac stress and risk of arrhythmias. 27 Third, crosstalk between the kidney and other organs involving inflammatory and proapoptotic pathways may result in multiorgan failure eventually causing death.…”

Section: Discussionmentioning

confidence: 99%

Association Between Acute Kidney Injury and In-Hospital Mortality in Patients Undergoing Percutaneous Coronary Interventions

Kooiman

Seth

Nallamothu

et al. 2015

A cute kidney injury (AKI) is a common complication of percutaneous coronary intervention (PCI) and is associated with increased morbidity, mortality, duration of hospital stay, and healthcare cost. [1][2][3] Although AKI is generally a reversible condition, patients developing this complication post PCI may experience up to 20-fold increase in their in-hospital mortality risk. 4 Interpretation of results reported by previous studies on the association between AKI and mortality post PCI is hampered by the fact that both outcomes share common risk factors, such as hemodynamic instability, heart failure, diabetes mellitus, and preexisting chronic kidney disease. It therefore remains unclear whether the occurrence of AKI is independently associated with mortality and if the mortality risk associated with AKI is clinically relevant in relation to the broader population of patients undergoing PCI. Our study seeks to address this gap in knowledge by studying the association between AKI and in-hospital mortality after adjustment for confounding by common risk factors among a large population undergoing contemporary PCI. Second, we analyzed the attributable risk fraction of AKI-related in-hospital mortality. MethodsThis study was performed using data from the Blue Cross Blue Shield of Michigan cardiovascular consortium (BMC2), a regional registry of all patients undergoing PCI at nonfederal hospitals in Michigan. A detailed outline of the BMC2 registry has previously been described.5-7 Briefly, consecutive patients undergoing PCI at the 47 participating centers were included. Data on procedural and demographic patient characteristics, medication, laboratory values, renal Background-Acute kidney injury (AKI) post percutaneous coronary intervention (PCI) is associated with increased mortality but both death and AKI share common risk factors. Moreover, the effect of a high contrast dose, a known modifiable risk factor for AKI, on mortality is unknown. The aim of our study was to analyze the association between AKI and in-hospital mortality post PCI after adjustment for confounding by common risk factors. Methods and Results-This study was performed using a regional registry of all patients undergoing PCI in Michigan.Primary end points were AKI (serum creatinine increase >0.5 mg/dL) and all-cause in-hospital mortality. Propensity matching was performed, with each AKI patient matched to 4 controls. Attributable risk fraction and the exposed index number of AKI for mortality were calculated within the propensity-matched cohort. Between 2010 and 2013, 92 317 patients underwent PCI, of whom 2141 (2.3%) developed AKI. We matched 1371/2141 patients with AKI to 5484 controls. AKI was strongly associated with mortality (odds ratio=12.52, 95% confidence interval 9.29-16.86) in the propensity-matched cohort. The attributable risk fraction for mortality of AKI was 31.4% (95% confidence interval 26.8%-37.5%), and one death could be prevented for every 9 cases of AKI successfully avoided. The independent impact of a high contrast dose a...