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Lu Y, Ni W, Qu X, Chen C, Shi S, Guo K, Lin K, Zhou H. Spironolactone for Preventing Contrast-Induced Nephropathy After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction and Chronic Kidney Disease. Angiology 2024:33197241251889. [PMID: 38679489 DOI: 10.1177/00033197241251889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Patients with acute myocardial infarction (AMI) and chronic kidney disease (CKD) are at high risk of contrast-induced nephropathy (CIN), which can subsequently worsen the overall prognosis. To evaluate the efficacy of spironolactone for CIN prevention, 410 patients with AMI and CKD receiving percutaneous coronary intervention (PCI) were retrospectively analyzed. Among them, 240 and 170 patients were enrolled in the standard treatment and spironolactone groups (spironolactone was administered 2 days before and 3 days after PCI), respectively. The primary endpoint of CIN was defined as a 0.5 mg/dL or >25% increase from the baseline serum creatinine level within 48-72 h post-PCI. CIN incidence was significantly lower in the spironolactone group than in the standard treatment group (11.2 vs 26.7%, P < .001). Further, cardiac re-hospitalization (hazard ratio [HR]: 0.515; 95% CI: 0.382-0.694; P < .001) and cardiac death (HR: 0.612; 95% CI: 0.429-0.872; P = .007) risks were significantly lower in patients who received long-term spironolactone with a median treatment duration of 42 months after discharge. Spironolactone might lower the risk of CIN, and long-term use of spironolactone reduces the risk of cardiac re-hospitalization and cardiac death in patients with AMI and CKD undergoing PCI.
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Affiliation(s)
- Yucheng Lu
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weicheng Ni
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang Qu
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Changxi Chen
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sanling Shi
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kun Guo
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ken Lin
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao Zhou
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Nakamura T, Watanabe M, Sugiura J, Kyodo A, Nobuta S, Nogi K, Nakada Y, Ishihara S, Hashimoto Y, Nakagawa H, Ueda T, Seno A, Nishida T, Onoue K, Hikoso S. Prognostic impact and predictors of persistent renal dysfunction in acute kidney injury after percutaneous coronary intervention for acute myocardial infarction. Sci Rep 2024; 14:6299. [PMID: 38491142 PMCID: PMC10943215 DOI: 10.1038/s41598-024-56929-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
This study aimed to evaluate the prognostic impact and predictors of persistent renal dysfunction in acute kidney injury (AKI) after an emergency percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). A total of 877 patients who underwent emergency PCI for AMI were examined. AKI was defined as serum creatinine (SCr) ≥ 0.3 mg/dL or ≥ 50% from baseline within 48 h after PCI. Persistent AKI was defined as residual impairment of SCr ≥ 0.3 mg/dL or ≥ 50% from baseline 1 month after the procedure. The primary outcome was the composite endpoints of death, myocardial infarction, hospitalization for heart failure, stroke, and dialysis. AKI and persistent AKI were observed in 82 (9.4%) and 25 (2.9%) patients, respectively. Multivariate Cox proportional hazards analysis demonstrated that persistent AKI, but not transient AKI, was an independent predictor of primary outcome (hazard ratio, 4.99; 95% confidence interval, 2.30-10.8; P < 0.001). Age > 75 years, left ventricular ejection fraction < 40%, a high maximum creatinine phosphokinase MB level, and bleeding after PCI were independently associated with persistent AKI. Persistent AKI was independently associated with worse clinical outcomes in patients who underwent emergency PCI for AMI. Advanced age, poor cardiac function, large myocardial necrosis, and bleeding were predictors of persistent AKI.
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Affiliation(s)
- Takuya Nakamura
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Junichi Sugiura
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Atsushi Kyodo
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Saki Nobuta
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kazutaka Nogi
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yasuki Nakada
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Satomi Ishihara
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hitoshi Nakagawa
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Ayako Seno
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Kim MJ, Jeon DS, Ahn Y, Byeon J, Lee D, Choi IJ. Systemic reserve dysfunction and contrast-associated acute kidney injury following percutaneous coronary intervention. PLoS One 2024; 19:e0299899. [PMID: 38442122 PMCID: PMC10914285 DOI: 10.1371/journal.pone.0299899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/17/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Developing contrast-associated acute kidney injury (CA-AKI) following percutaneous coronary intervention (PCI) is closely related to patient-related risk factors as well as contrast administration. The diagnostic and prognostic roles of neutrophil gelatinase-associated lipocalin (NGAL) in CA-AKI following PCI are not well established. METHODS Consecutive patients undergoing PCI were enrolled prospectively. CA-AKI was defined as an increase in the serum creatinine level ≥0.3 mg/dL within 48 hours or ≥1.5 times the baseline within 7 days after PCI. Serum NGAL concentrations were determined immediately before and 6 hours after PCI. The participants were classified into four NGAL groups according to the pre- and post-PCI NGAL values at 75th percentile. RESULTS CA-AKI occurred in 38 (6.4%) of 590 patients. With chronic kidney disease status (hazard ratio [HR] 1.63, 95% confidence interval [CI]: 1.06-2.52), NGAL groups defined by the combination of pre- and 6 h post-PCI values were independently associated with the occurrence of CA-AKI (HR 1.69, 95% CI: 1.16-2.45). All-cause mortality for 29-month follow-ups was different among NGAL groups (log-rank p<0.001). Pre-PCI NGAL levels significantly correlated with baseline cardiac, inflammatory, and renal markers. Although post-PCI NGAL levels increased in patients with larger contrast administration, contrast media made a relatively limited contribution to the development of CA-AKI. CONCLUSION In patients undergoing PCI, the combination of pre- and post-PCI NGAL values may be a useful adjunct to current risk-stratification of CA-AKI and long-term mortality. CA-AKI is likely caused by systemic reserve deficiency rather than contrast administration itself.
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Affiliation(s)
- Mi-Jeong Kim
- Department of Cardiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Doo Soo Jeon
- Department of Cardiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youngchul Ahn
- Department of Cardiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Jaeho Byeon
- Department of Cardiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Dongjae Lee
- Department of Cardiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Ik Jun Choi
- Department of Cardiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
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4
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Landi A, Chiarito M, Branca M, Frigoli E, Gagnor A, Calabrò P, Briguori C, Andò G, Repetto A, Limbruno U, Sganzerla P, Lupi A, Cortese B, Ausiello A, Ierna S, Esposito G, Ferrante G, Santarelli A, Sardella G, Varbella F, Heg D, Mehran R, Valgimigli M. Validation of a Contemporary Acute Kidney Injury Risk Score in Patients With Acute Coronary Syndrome. JACC Cardiovasc Interv 2023; 16:1873-1886. [PMID: 37587595 DOI: 10.1016/j.jcin.2023.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 08/18/2023]
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).
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Affiliation(s)
- Antonio Landi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Emanuele, Italy
| | | | - Enrico Frigoli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Paolo Calabrò
- Division of Cardiology, "Sant'Anna e San Sebastiano" Hospital, Caserta, Italy; Department of Translational Medicine, University of Campania "Luigi Vanvitelli," Caserta, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Giuseppe Andò
- Cardiology Unit, Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino," University of Messina, Messina, Italy
| | | | - Ugo Limbruno
- Cardiology Department, Misericordia Hospital, Grosseto, Italy
| | - Paolo Sganzerla
- IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
| | - Alessandro Lupi
- Division of Cardiology, Hospital of Domodossola, Domodossola, Verbano-Cusio-Ossola, Italy
| | - Bernardo Cortese
- Cardiovascular Research Center, Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | | | - Salvatore Ierna
- Interventional Cardiology Unit, Ospedale di Carbonia, Carbonia, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Ferrante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Cardiovascular Medicine, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | | | - Gennaro Sardella
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Ferdinando Varbella
- Cardiology Unit, Azienda Ospedaliera Universitaria San Luigi Gonzaga Orbassano, Turin, Italy
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland.
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5
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Brown JR, Solomon R, Stabler ME, Davis S, Carpenter-Song E, Zubkoff L, Westerman DM, Dorn C, Cox KC, Minter F, Jneid H, Currier JW, Athar SA, Girotra S, Leung C, Helton TJ, Agarwal A, Vidovich MI, Plomondon ME, Waldo SW, Aschbrenner KA, O'Malley AJ, Matheny ME. Team-Based Coaching Intervention to Improve Contrast-Associated Acute Kidney Injury: A Cluster-Randomized Trial. Clin J Am Soc Nephrol 2023; 18:315-326. [PMID: 36787125 PMCID: PMC10103221 DOI: 10.2215/cjn.0000000000000067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/19/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Up to 14% of patients in the United States undergoing cardiac catheterization each year experience AKI. Consistent use of risk minimization preventive strategies may improve outcomes. We hypothesized that team-based coaching in a Virtual Learning Collaborative (Collaborative) would reduce postprocedural AKI compared with Technical Assistance (Assistance), both with and without Automated Surveillance Reporting (Surveillance). METHODS The IMPROVE AKI trial was a 2×2 factorial cluster-randomized trial across 20 Veterans Affairs medical centers (VAMCs). Participating VAMCs received Assistance, Assistance with Surveillance, Collaborative, or Collaborative with Surveillance for 18 months to implement AKI prevention strategies. The Assistance and Collaborative approaches promoted hydration and limited NPO and contrast dye dosing. We fit logistic regression models for AKI with site-level random effects accounting for the clustering of patients within medical centers with a prespecified interest in exploring differences across the four intervention arms. RESULTS Among VAMCs' 4517 patients, 510 experienced AKI (235 AKI events among 1314 patients with preexisting CKD). AKI events in each intervention cluster were 110 (13%) in Assistance, 122 (11%) in Assistance with Surveillance, 190 (13%) in Collaborative, and 88 (8%) in Collaborative with Surveillance. Compared with sites receiving Assistance alone, case-mix-adjusted differences in AKI event proportions were -3% (95% confidence interval [CI], -4 to -3) for Assistance with Surveillance, -3% (95% CI, -3 to -2) for Collaborative, and -5% (95% CI, -6 to -5) for Collaborative with Surveillance. The Collaborative with Surveillance intervention cluster had a substantial 46% reduction in AKI compared with Assistance alone (adjusted odds ratio=0.54; 0.40-0.74). CONCLUSIONS This implementation trial estimates that the combination of Collaborative with Surveillance reduced the odds of AKI by 46% at VAMCs and is suggestive of a reduction among patients with CKD. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER IMPROVE AKI Cluster-Randomized Trial (IMPROVE-AKI), NCT03556293.
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Affiliation(s)
- Jeremiah R. Brown
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Richard Solomon
- University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Meagan E. Stabler
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Sharon Davis
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth Carpenter-Song
- Department of Psychiatry and Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Lisa Zubkoff
- Department of Medicine, University of Alabama at Birmingham and VA Birmingham Health Care, Birmingham, Alabama
| | - Dax M. Westerman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chad Dorn
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin C. Cox
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Freneka Minter
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hani Jneid
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jesse W. Currier
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - S. Ahmed Athar
- Section of Cardiology, Loma Linda VA Medical Center, Loma Linda, California
- Department of Medicine, Division of Cardiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Saket Girotra
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Ajay Agarwal
- Wright State University Dayton VA Medical Center, Dayton, Ohio
| | - Mladen I. Vidovich
- Section of Cardiology, Jesse Brown VA Medical Center and Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | - Stephen W. Waldo
- CART Program, VHA Office of Quality and Safety, Washington, DC
- Department of Medicine, Cardiology Section, Rocky Mountain Regional VA Medical Center, Aurora, Colorado
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Kelly A. Aschbrenner
- Department of Psychiatry and Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - A. James O'Malley
- Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Michael E. Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville, Tennessee
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Landi A, Branca M, Leonardi S, Frigoli E, Vranckx P, Tebaldi M, Varbella F, Calabró P, Esposito G, Sardella G, Garducci S, Andò G, Limbruno U, Sganzerla P, Santarelli A, Briguori C, Colangelo S, Brugaletta S, Adamo M, Omerovic E, Heg D, Windecker S, Valgimigli M. Transient vs In-Hospital Persistent Acute Kidney Injury in Patients With Acute Coronary Syndrome. JACC Cardiovasc Interv 2023; 16:193-205. [PMID: 36697156 DOI: 10.1016/j.jcin.2022.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The occurrence of acute kidney injury (AKI) among patients with acute coronary syndrome (ACS) undergoing invasive management is associated with worse outcomes. However, the prognostic implications of transient or in-hospital persistent AKI may differ. OBJECTIVES The aim of this study was to evaluate the prognostic implications of transient or in-hospital persistent AKI in patients with ACS. METHODS In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial, 203 subjects were excluded because of incomplete information or end-stage renal disease, with a study population of 8,201 patients. Transient and persistent AKI were defined as renal dysfunction no longer or still fulfilling the AKI criteria (>0.5 mg/dL or a relative >25% increase in creatinine) at discharge, respectively. Thirty-day coprimary outcomes were the out-of-hospital composite of death, myocardial infarction, or stroke (major adverse cardiovascular events [MACE]) and net adverse cardiovascular events (NACE), defined as the composite of MACE or Bleeding Academic Research Consortium type 3 or 5 bleeding. RESULTS Persistent and transient AKI occurred in 750 (9.1%) and 587 (7.2%) subjects, respectively. After multivariable adjustment, compared with patients without AKI, the risk for 30-day coprimary outcomes was higher in patients with persistent AKI (MACE: adjusted HR: 2.32; 95% CI: 1.48-3.64; P < 0.001; NACE: adjusted HR: 2.29; 95% CI: 1.48-3.52; P < 0.001), driven mainly by all-cause mortality (adjusted HR: 3.43; 95% CI: 2.03-5.82; P < 0.001), whereas transient AKI was not associated with higher rates of MACE or NACE. Results remained consistent when implementing the KDIGO (Kidney Disease Improving Global Outcomes) criteria. CONCLUSIONS Among patients with ACS undergoing invasive management, in-hospital persistent but not transient AKI was associated with higher risk for 30-day MACE and NACE. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox [MATRIX]; NCT01433627).
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Affiliation(s)
- Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Frigoli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; CTU Bern, University of Bern, Switzerland
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Ferdinando Varbella
- Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3, Turin, Italy; Cardiology Unit, Azienda Ospedaliera Universitaria San Luigi Gonzaga Orbassano, Turin, Italy
| | - Paolo Calabró
- Division of Cardiology, "Sant'Anna e San Sebastiano" Hospital, Caserta, Italy; Department of Translational Medicine, University of Campania "Luigi Vanvitelli," Caserta, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Gennaro Sardella
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Giuseppe Andò
- Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino," University of Messina, Messina, Italy
| | - Ugo Limbruno
- Cardiology Department, Misericordia Hospital, Grosseto, Italy
| | - Paolo Sganzerla
- IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milano
| | | | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | | | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dik Heg
- CTU Bern, University of Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland.
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7
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BMI Modifies Increased Mortality Risk of Post-PCI STEMI Patients with AKI. J Clin Med 2022; 11:jcm11206104. [PMID: 36294425 PMCID: PMC9604849 DOI: 10.3390/jcm11206104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/29/2022] [Accepted: 10/13/2022] [Indexed: 11/25/2022] Open
Abstract
Mortality from acute ST elevation myocardial infarction (STEMI) was significantly reduced with the introduction of percutaneous catheterization intervention (PCI) but remains high in patients who develop acute kidney injury (AKI). Previous studies found overweight to be protective from mortality in patients suffering from STEMI and AKI separately but not as they occur concurrently. This study aimed to establish the relationship between AKI and mortality in STEMI patients after PCI and whether body mass index (BMI) has a protective impact. Between January 2008 and June 2016, two thousand one hundred and forty-one patients with STEMI underwent PCI and were admitted to the Tel Aviv Medical Center Cardiac Intensive Care Unit. Their demographic, laboratory, and clinical data were collected and analyzed. We compared all-cause mortality in patients who developed AKI after PCI for STEMI and those who did not. In total, 178 patients (10%) developed AKI and had higher mortality (p < 0.001). Logistic regression analysis was performed to determine the relationship between AKI, BMI, and mortality. AKI was significantly associated with both 30-day and overall mortality, while BMI had a significant protective effect. Survival analysis found a significant difference in 30-day and overall survival between patients with and without AKI with a significant protective effect of BMI on survival at 30 days. AKI presents a major risk for mortality and poor survival after PCI for STEMI, yet a beneficial effect of increased BMI modifies it.
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8
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Chaudhari H, Mahendrakar S, Baskin SE, Reddi AS. Contrast-Induced Acute Kidney Injury: Evidence in Support of Its Existence and a Review of Its Pathogenesis and Management. Int J Nephrol Renovasc Dis 2022; 15:253-266. [PMID: 36311164 PMCID: PMC9604418 DOI: 10.2147/ijnrd.s371700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022] Open
Abstract
The role of contrast-induced nephropathy (CIN) remains controversial. Many experts contend that CIN does not exist or is extremely rare. The diagnosis was previously made too frequently and inappropriately in the presence of coexisting and confounding comorbidities and risk factors making it difficult to singularly isolate the etiologic role of intravenous contrast media in acute kidney injury (AKI). It is probable that many patients were denied important diagnostic information from radiocontrast studies for fear of CIN. Recently, a new terminology for CIN was introduced, and the term CIN was replaced by two interrelated new terms: one is contrast-associated acute kidney injury (CA-AKI), and the second one is contrast-induced acute kidney injury (CI-AKI). CA-AKI occurs in association with risk factors or comorbidities, therefore, it is a correlative diagnosis. On the other hand, CI-AKI is a subtype of CA-AKI that results directly from iodinated contrast media. In this review, we present evidence from various studies that argue against CI-AKI and also those that suggest its existence but with much lower frequency. We will also provide the current status of the pathophysiology and management of CA-AKI/CI-AKI.
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Affiliation(s)
- Harshad Chaudhari
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA,Correspondence: Harshad Chaudhari, Email
| | - Smita Mahendrakar
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Stuart E Baskin
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Alluru S Reddi
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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9
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Isaac T, Gilani S, Kleiman NS. When Prevention is Truly Better than Cure: Contrast-Associated Acute Kidney Injury in Percutaneous Coronary Intervention. Methodist Debakey Cardiovasc J 2022; 18:73-85. [PMID: 36132584 PMCID: PMC9461685 DOI: 10.14797/mdcvj.1136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/01/2022] [Indexed: 11/08/2022] Open
Abstract
Contrast-associated acute kidney injury (CA-AKI) is a fairly frequent complication of cardiovascular angiography and percutaneous coronary intervention (PCI). The risk is significantly higher in patients with advanced chronic kidney disease (CKD). Prevention is the only option for avoiding the significant morbidity and mortality associated with CA-AKI. This review provides a concise and clinically directed appraisal of the latest pre-procedural and peri-procedural strategies to minimize the risk of CA-AKI in all patients undergoing PCI. By broadly implementing these evidence-based care bundles, we can dramatically improve outcomes in this vulnerable patient population.
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Affiliation(s)
- Tea Isaac
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Salima Gilani
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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10
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Davis SE, Brown JR, Dorn C, Westerman D, Solomon RJ, Matheny ME. Maintaining a National Acute Kidney Injury Risk Prediction Model to Support Local Quality Benchmarking. Circ Cardiovasc Qual Outcomes 2022; 15:e008635. [PMID: 35959674 PMCID: PMC9388604 DOI: 10.1161/circoutcomes.121.008635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The utility of quality dashboards to inform decision-making and improve clinical outcomes is tightly linked to the accuracy of the information they provide and, in turn, accuracy of underlying prediction models. Despite recognition of the need to update prediction models to maintain accuracy over time, there is limited guidance on updating strategies. We compare predefined and surveillance-based updating strategies applied to a model supporting quality evaluations among US veterans. METHODS We evaluated the performance of a US Department of Veterans Affairs-specific model for postcardiac catheterization acute kidney injury using routinely collected observational data over the 6 years following model development (n=90 295 procedures in 2013-2019). Predicted probabilities were generated from the original model, an annually retrained model, and a surveillance-based approach that monitored performance to inform the timing and method of updates. We evaluated how updating the national model impacted regional quality profiles. We compared observed-to-expected outcome ratios, where values above and below 1 indicated more and fewer adverse outcomes than expected, respectively. RESULTS The original model overpredicted risk at the national level (observed-to-expected outcome ratio, 0.75 [0.74-0.77]). Annual retraining updated the model 5×; surveillance-based updating retrained once and recalibrated twice. While both strategies improved performance, the surveillance-based approach provided superior calibration (observed-to-expected outcome ratio, 1.01 [0.99-1.03] versus 0.94 [0.92-0.96]). Overprediction by the original model led to optimistic quality assessments, incorrectly indicating most of the US Department of Veterans Affairs' 18 regions observed fewer acute kidney injury events than predicted. Both updating strategies revealed 16 regions performed as expected and 2 regions increasingly underperformed, having more acute kidney injury events than predicted. CONCLUSIONS Miscalibrated clinical prediction models provide inaccurate pictures of performance across clinical units, and degrading calibration further complicates our understanding of quality. Updating strategies tailored to health system needs and capacity should be incorporated into model implementation plans to promote the utility and longevity of quality reporting tools.
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Affiliation(s)
- Sharon E. Davis
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Jeremiah R. Brown
- Departments of Epidemiology and Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Chad Dorn
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Dax Westerman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Richard J. Solomon
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Michael E. Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Healthcare System VA Medical Center, Veterans Health Administration, Nashville, TN, USA
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11
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Abstract
AKI is a potential complication of intravascular iodinated contrast exposure. Contrast-associated AKI, which typically manifests as small and transient decrements in kidney function that develop within several days of contrast administration, is associated with serious adverse outcomes, including progressive kidney dysfunction and death. However, a causal link between the small increases in serum creatinine that characteristically occur with contrast-associated AKI and serious adverse outcomes remains unproven. This is important given mounting evidence that clinically indicated, potentially lifesaving radiographic procedures are underutilized in patients with CKD. This has been hypothesized to be related to provider concern about precipitating contrast-associated AKI. Intravascular gadolinium-based contrast, an alternative to iodinated contrast that is administered with magnetic resonance imaging, has also been linked with potential serious adverse events, notably the development of nephrogenic systemic fibrosis in patients with severe impairment in kidney function. Patients hospitalized in the intensive care unit frequently have clinical indications for diagnostic and therapeutic procedures that involve the intravascular administration of contrast media. Accordingly, critical care providers and others treating critically ill patients should possess a sound understanding of the risk factors for and incidence of such outcomes, the ability to perform evidence-based risk-benefit assessments regarding intravascular contrast administration, and knowledge of empirical data on the prevention of these iatrogenic complications.
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Affiliation(s)
- Winn Cashion
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven D Weisbord
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania .,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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12
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Mirza AJ, Ali K, Huwez F, Taha AY, Ahmed FJ, Ezzaddin SA, Abdulrahman ZI, Lang CC. Contrast Induced Nephropathy: Efficacy of matched hydration and forced diuresis for prevention in patients with impaired renal function undergoing coronary procedures-CINEMA trial. IJC HEART & VASCULATURE 2022; 39:100959. [PMID: 35146119 PMCID: PMC8818567 DOI: 10.1016/j.ijcha.2022.100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/17/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Matched hydration and forced diuresis (MHFD) using the RenalGuard device has been shown to reduce contrast induced nephropathy (CIN) following coronary interventions. AIM To evaluate the potential benefits of a non-automated MHFD protocol compared to current hydration protocol in prevention of CIN in patients with CKD. METHODS A total of 1,205 patients were randomized to either non-automated MHFD group (n = 799) or intravenous hydration control group (n = 406). The MHFD group received 250 ml IV normal saline over 30 min before the coronary procedure followed by 0.5 mg/kg IV furosemide. Hydration infusion rate was manually adjusted to replace the patient's urine output. When urine output rate reached > 300 ml/h, patients underwent coronary procedure. Matched fluid replacement was maintained during the procedure and for 4-hour post-treatment. CIN was defined conventionally as ≥ 25% or ≥ 0.5 mg/dl rise in serum creatinine over baseline. RESULTS CIN occurred in 121 of 1,205 (10.0%) patients in our study. With respect to the primary outcome, 64 (8.01%) of the MHFD patients developed CIN compared with 57 (14.04%) of the control group (p < 0.001). CONCLUSIONS A non-automated MHFD protocol is an effective and safe method for the prevention of CIN in patients with CKD.
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Affiliation(s)
- Aram J. Mirza
- Department of Interventional Cardiology, Slemani Cardiac Hospital, Sulaymaniyah, Region of Kurdistan, Iraq
| | - Kashan Ali
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, UK
| | - Farhad Huwez
- Royal London Hospital, Hyper-acute Stroke Unit, Whitechapel, London, UK
| | - Abdulsalam Y. Taha
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, University of Sulaimani, Sulaymaniyah, Region of Kurdistan, Iraq
| | - Farman J. Ahmed
- Department of Interventional Cardiology, Slemani Cardiac Hospital, Sulaymaniyah, Region of Kurdistan, Iraq
| | - Shahow A. Ezzaddin
- Department of Family and Community Medicine, College of Medicine, University of Sulaimani, Sulaymaniyah, Region of Kurdistan, Iraq
| | - Zana I. Abdulrahman
- Shorsh General Hospital, Peshmarga Health Foundation, Ministry of Peshmarga, Region of Kurdistan, Iraq
| | - Chim C. Lang
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, UK
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13
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Shimura D, Nuebel E, Baum R, Valdez SE, Xiao S, Warren JS, Palatinus JA, Hong T, Rutter J, Shaw RM. Protective mitochondrial fission induced by stress-responsive protein GJA1-20k. eLife 2021; 10:69207. [PMID: 34608863 PMCID: PMC8492060 DOI: 10.7554/elife.69207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/09/2021] [Indexed: 12/13/2022] Open
Abstract
The Connexin43 gap junction gene GJA1 has one coding exon, but its mRNA undergoes internal translation to generate N-terminal truncated isoforms of Connexin43 with the predominant isoform being only 20 kDa in size (GJA1-20k). Endogenous GJA1-20k protein is not membrane bound and has been found to increase in response to ischemic stress, localize to mitochondria, and mimic ischemic preconditioning protection in the heart. However, it is not known how GJA1-20k benefits mitochondria to provide this protection. Here, using human cells and mice, we identify that GJA1-20k polymerizes actin around mitochondria which induces focal constriction sites. Mitochondrial fission events occur within about 45 s of GJA1-20k recruitment of actin. Interestingly, GJA1-20k mediated fission is independent of canonical Dynamin-Related Protein 1 (DRP1). We find that GJA1-20k-induced smaller mitochondria have decreased reactive oxygen species (ROS) generation and, in hearts, provide potent protection against ischemia-reperfusion injury. The results indicate that stress responsive internally translated GJA1-20k stabilizes polymerized actin filaments to stimulate non-canonical mitochondrial fission which limits ischemic-reperfusion induced myocardial infarction.
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Affiliation(s)
- Daisuke Shimura
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, United States
| | - Esther Nuebel
- Howard Hughes Medical Institute, University of Utah, Salt Lake City, United States.,Department of Biochemistry, University of Utah, Salt Lake City, United States.,Biomedical Sciences, Noorda College of Osteopathic Medicine, Provo, United States
| | - Rachel Baum
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, United States
| | - Steven E Valdez
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, United States
| | - Shaohua Xiao
- Department of Neurology, University of California at Los Angeles, Los Angeles, United States
| | - Junco S Warren
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, United States
| | - Joseph A Palatinus
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, United States
| | - TingTing Hong
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, United States.,Diabetes and Metabolism Research Center, University of Utah, Salt Lake City, United States.,Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, United States
| | - Jared Rutter
- Howard Hughes Medical Institute, University of Utah, Salt Lake City, United States.,Department of Biochemistry, University of Utah, Salt Lake City, United States.,Diabetes and Metabolism Research Center, University of Utah, Salt Lake City, United States
| | - Robin M Shaw
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, United States
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14
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Liu T, Lee SR. Poor Prognosis of Contrast-Induced Nephropathy during Long Term Follow Up. Chonnam Med J 2021; 57:197-203. [PMID: 34621640 PMCID: PMC8485089 DOI: 10.4068/cmj.2021.57.3.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/06/2022] Open
Abstract
Contrast-induced nephropathy (CIN) is known to associate with poor prognosis. However, there have been few studies for long-term follow up. The purpose of this study was to know the prognosis of CIN during a 10-year follow up. We retrospectively analyzed 528 patients who underwent coronary angiography in Jeonbuk National University Hospital (South Korea, Jeonju) between Jan 2005 to Dec 2006. We excluded the patients who required regular dialysis before study enrollment. We compared adverse events in the no CIN (group I, n=485, 61.9±11.4 years, male 64.1%) and CIN (group II, n=43, 65.7±11.1 years, male 62.8%). Baseline clinical characteristics and cardiovascular risk factors were not different between the two groups except the post-procedure creatinine level (1.04 mg/dL vs 1.84 mg/dL, p=0.0001). The higher rates of all-cause death were observed in group II at 1-year (3.7% vs 13.9%, log-rank, p=0.001), 5-years (17.9% vs 34.9%, log-rank, p=0.003), and 10-years (25.3% vs 48.8%, log-rank, p=0.000). MACE was higher in group II at 1-year (3.9% vs 11.6%, log-rank, p=0.013), 5-years (6.8% vs 20.9%, log-rank, p=0.000) and 10-years (13.4% vs 27.9%, log-rank, p=0.000). In addition, CIN was an independent predictor for 10-year MACE (adjusted HR 3.432, 95% CI 1.314-8.965, p=0.012) after propensity score matching. The worse prognosis of CIN was continuously observed after the 10-year follow-up. Our data suggests that it is worthwhile to prevent the appearance of CIN in order to improve longterm results.
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Affiliation(s)
- Taili Liu
- Division of Cardiology, Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Sang-Rok Lee
- Division of Cardiology, Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
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15
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Gąsecka A, Bury A, Mierzejewska M, Pietrasik A. Challenging two-staged percutaneous coronary intervention in multivessel coronary artery disease with a high SYNTAX score: feasible, yet complicated. Arch Med Sci Atheroscler Dis 2021; 6:e120-e122. [PMID: 34381912 PMCID: PMC8336436 DOI: 10.5114/amsad.2021.107812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/02/2021] [Indexed: 11/25/2022] Open
Abstract
Coronary artery disease (CAD) revascularization either by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) improves the prognosis in patients with chronic coronary syndrome [1]. Whereas PCI is the gold standard for single-vessel disease, the choice of treatment for multivessel disease (MVD) is more challenging.
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Affiliation(s)
- Aleksandra Gąsecka
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Bury
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Arkadiusz Pietrasik
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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16
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Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies. J Clin Med 2021; 10:jcm10102151. [PMID: 34065642 PMCID: PMC8156026 DOI: 10.3390/jcm10102151] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/31/2022] Open
Abstract
Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent coronary angiography. The occurrence of CA-AKI was defined based on KDIGO criteria. The primary outcome of the study was to test the relation between CA-AKI and 3-month mortality. Overall, 870 older ACS adults were included in the analysis (mean age 78 ± 5 years; 28% females). CA-AKI occurred in 136 (16%) patients. At 3 months, 13 (9.6%) patients with CA-AKI died as compared with 13 (1.8%) without it (p < 0.001). At multivariable analysis, CA-AKI emerged as independent predictor of 3-month mortality (HR 3.51, 95%CI 1.05–7.01). After 3 months, renal function returned to the baseline value in 78 (63%) with CA-AKI. Those without recovered renal function (n = 45, 37%) showed an increased risk of mortality as compared to recovered renal function and no CA-AKI subgroups (HR 2.01, 95%CI 1.55–2.59, p = 0.009 and HR 2.71, 95%CI 1.45–5.89, p < 0.001, respectively). In conclusion, CA-AKI occurs in a not negligible portion of older MI patients undergoing invasive strategy and it is associated with short-term mortality.
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17
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Julien HM, Stebbins A, Vemulapalli S, Nathan AS, Eneanya ND, Groeneveld P, Fiorilli PN, Herrmann HC, Szeto WY, Desai ND, Anwaruddin S, Vora A, Shah B, Ng VG, Kumbhani DJ, Giri J. Incidence, Predictors, and Outcomes of Acute Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From the Society of Thoracic Surgeons/American College of Cardiology National Cardiovascular Data Registry-Transcatheter Valve Therapy Registry. Circ Cardiovasc Interv 2021; 14:e010032. [PMID: 33877860 DOI: 10.1161/circinterventions.120.010032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Howard M Julien
- Division of Cardiovascular Medicine (H.M.J., A.S.N., P.N.F., H.C.H., W.Y.S., N.D.D., S.A., J.G.), University of Pennsylvania, Philadelphia, PA
| | | | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, NC (A.S., S.V.).,Duke University Health System, Duke Heart Center, Division of Cardiology, Durham, NC (S.V., J.G.)
| | - Ashwin S Nathan
- Division of Cardiovascular Medicine (H.M.J., A.S.N., P.N.F., H.C.H., W.Y.S., N.D.D., S.A., J.G.), University of Pennsylvania, Philadelphia, PA.,Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center (A.S.N., P.G., N.D.D., J.G.), University of Pennsylvania, Philadelphia, PA.,Perelman School of Medicine and The Leonard Davis Institute of Health Economics (A.S.N., N.D.E., P.G., N.D.D.), University of Pennsylvania, Philadelphia, PA
| | - Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division (N.D.E.), Palliative and Advanced Illness Research Center (N.D.E.), University of Pennsylvania, Philadelphia, PA.,Perelman School of Medicine and The Leonard Davis Institute of Health Economics (A.S.N., N.D.E., P.G., N.D.D.), University of Pennsylvania, Philadelphia, PA
| | - Peter Groeneveld
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center (A.S.N., P.G., N.D.D., J.G.), University of Pennsylvania, Philadelphia, PA.,Division of General Internal Medicine (P.G.), University of Pennsylvania, Philadelphia, PA.,Perelman School of Medicine and The Leonard Davis Institute of Health Economics (A.S.N., N.D.E., P.G., N.D.D.), University of Pennsylvania, Philadelphia, PA.,Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (P.G.)
| | - Paul N Fiorilli
- Division of Cardiovascular Medicine (H.M.J., A.S.N., P.N.F., H.C.H., W.Y.S., N.D.D., S.A., J.G.), University of Pennsylvania, Philadelphia, PA
| | - Howard C Herrmann
- Division of Cardiovascular Medicine (H.M.J., A.S.N., P.N.F., H.C.H., W.Y.S., N.D.D., S.A., J.G.), University of Pennsylvania, Philadelphia, PA
| | - Wilson Y Szeto
- Division of Cardiovascular Medicine (H.M.J., A.S.N., P.N.F., H.C.H., W.Y.S., N.D.D., S.A., J.G.), University of Pennsylvania, Philadelphia, PA
| | - Nimesh D Desai
- Division of Cardiovascular Medicine (H.M.J., A.S.N., P.N.F., H.C.H., W.Y.S., N.D.D., S.A., J.G.), University of Pennsylvania, Philadelphia, PA.,Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center (A.S.N., P.G., N.D.D., J.G.), University of Pennsylvania, Philadelphia, PA.,Perelman School of Medicine and The Leonard Davis Institute of Health Economics (A.S.N., N.D.E., P.G., N.D.D.), University of Pennsylvania, Philadelphia, PA
| | - Saif Anwaruddin
- Division of Cardiovascular Medicine (H.M.J., A.S.N., P.N.F., H.C.H., W.Y.S., N.D.D., S.A., J.G.), University of Pennsylvania, Philadelphia, PA
| | - Amit Vora
- University of Pittsburgh Medical Center-Pinnacle, Wormleysburg, PA (A.V.)
| | | | - Vivian G Ng
- Columbia University Medical Center, New York, New York (V.G.N.)
| | - Dharam J Kumbhani
- Division of Cardiology, UT Southwestern Medical Center, Dallas (D.J.K.)
| | - Jay Giri
- Division of Cardiovascular Medicine (H.M.J., A.S.N., P.N.F., H.C.H., W.Y.S., N.D.D., S.A., J.G.), University of Pennsylvania, Philadelphia, PA.,Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center (A.S.N., P.G., N.D.D., J.G.), University of Pennsylvania, Philadelphia, PA.,Duke University Health System, Duke Heart Center, Division of Cardiology, Durham, NC (S.V., J.G.)
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18
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Jeyaruban A, Hoy W, Cameron A, Healy H, Wang Z, Zhang J, Mallett A. Determining the association between the type of intervention for ischaemic heart disease and mortality and morbidity in patients with chronic kidney disease. Intern Med J 2021; 52:1190-1195. [PMID: 33755278 DOI: 10.1111/imj.15297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 03/07/2021] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Association between chronic kidney disease (CKD) and ischaemic heart disease (IHD) is well known. Clinically, because of the use of intra-arterial contrast, coronary angiograms are sometimes not performed to avoid further deterioration in kidney function amongst CKD patients. Therefore, our aim is to identify whether intervention for non-ST elevation myocardial infarction (NStemi) is associated with increased mortality or further renal deterioration. METHOD A retrospective observational cohort study was undertaken involving 144 patients with diagnosis of IHD in the CKD.QLD registry from May 2011 to August 2017, with minimum of 2 years follow-up. Patients were divided into two groups based on whether they obtained an interventional or medical management for NStemi. RESULTS 59 patients had medical management and 85 patients had intervention for IHD. Patients in the medical management group were observed to be significantly older (median:78vs69years,p<0.05) with worse baseline renal function (median:31vs36ml/min/1.73m3 ,<0.05) and higher serum urate level (median:0.5vs0.4mmol/L,p=0.2). The interventional group had lower prevalence of diabetes, dyslipidaemia, cerebrovascular disease and peripheral vascular disease, , although this was not significant Kaplan-Meier analysis revealed a significant decrease in mean survival of medically managed group compared to interventional group. Furthermore, post adjustment for age and above comorbidities, medically managed group and higher age were associated with significantly higher mortality. However, the patients in the medically managed and interventional groups had no significant difference in delta eGFR. CONCLUSION In this observational study, intervention for IHD was associated with increased survival with no change in renal disease progression in comparison to medically managed patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- A Jeyaruban
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD.,Kidney Health Service, Royal Brisbane and Women's Hospital, Herston, QLD
| | - W Hoy
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD
| | - A Cameron
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD
| | - H Healy
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD.,Kidney Health Service, Royal Brisbane and Women's Hospital, Herston, QLD
| | - Z Wang
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD
| | - J Zhang
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD
| | - A Mallett
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD.,Kidney Health Service, Royal Brisbane and Women's Hospital, Herston, QLD
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19
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Nunes S, Brown J, Parikh CR, Greenberg JH, Devarajan P, Philbrook HT, Pizzi M, Palijan A, Zappitelli M. The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgery. JTCVS OPEN 2020; 4:70-85. [PMID: 36004303 PMCID: PMC9390193 DOI: 10.1016/j.xjon.2020.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022]
Abstract
Background Acute kidney injury (AKI) in children undergoing cardiac surgery (CS) is strongly associated with increased hospital mortality and length of stay. The association of AKI with postdischarge outcomes is unclear. We evaluated the association of AKI with all-cause readmissions and death within 30 days and 1 year of CS discharge. Methods This was a prospective, 3-center cohort study of children after CS with cardiopulmonary bypass. The primary exposures were postoperative ≥stage 1 AKI and ≥stage 2 AKI defined by Kidney Disease: Improving Global Outcomes AKI definition. Two separate outcomes were hospital readmission and death within 30 days and 1 year of discharge. Association of AKI with time to outcomes was determined using multivariable Cox-proportional hazards analysis. Age, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery risk adjustment tool score ≥3, cardiopulmonary bypass >120 minutes, and cyanotic heart disease were evaluated as effect modifiers. Results Of 402 participants included (median age 1.8 years [interquartile range 0.4, 5.2]), 32 (8.0%) and 109 (27.1%) were readmitted; 7 (1.7%) and 9 (2.2%) died within 30 days and 1 year of CS, respectively. AKI was not associated with readmission at 30 days or 1 year postdischarge. ≥Stage 2 AKI (adjusted hazard ratio, 11.68 [1.88, 72.61]) was associated with mortality 30 days post-CS. Conclusions Postoperative AKI was not associated with readmission at 30 days and 1-year postdischarge. However, more severe AKI (≥stage 2) appears to be associated with increased morality risk at 30 days post-CS.
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Affiliation(s)
- Sophia Nunes
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeremiah Brown
- Departments of Epidemiology and Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Chirag R. Parikh
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Jason H. Greenberg
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Conn
| | - Prasad Devarajan
- Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Michael Pizzi
- McGill University Health Research Institute Centre, Montreal, Québec, Canada
| | - Ana Palijan
- McGill University Health Research Institute Centre, Montreal, Québec, Canada
| | - Michael Zappitelli
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Address for reprints: Michael Zappitelli, MD, MSc, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St, 11th Floor, Room 11.9722, Toronto, Ontario, M5G 0A4 Canada.
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20
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Long-term renal outcomes after elective percutaneous coronary intervention in patients with advanced renal dysfunction. Heart Vessels 2020; 36:452-460. [PMID: 33151381 DOI: 10.1007/s00380-020-01720-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
The aim of the present study was to evaluate the renal outcomes, including the time course of renal function, after elective PCI in patients with advanced renal dysfunction and to assess the predictors of renal dysfunction progression. This is a subanalysis of a previous observational multicenter study that investigated long-term clinical outcomes in patients with advanced renal dysfunction (eGFR < 30 mL/min/1.73 m2), focusing on 151 patients who underwent elective PCI and their long-term renal outcomes. Renal dysfunction progression was defined as a 20% relative decrease in eGFR at 1 year from baseline or the initiation of permanent dialysis within 1 year. Progression of renal dysfunction at 1 year occurred in 42 patients (34.1%). Among patients with renal dysfunction progression, the decrease of renal function from baseline was not observed at 1 month but after 6 months of the index PCI. Baseline eGFR and serum albumin level were significant predictors of renal dysfunction progression at 1 year. Among 111 patients who had not been initiated on dialysis within 1 year, those with renal dysfunction progression had a significantly higher incidence of dialysis initiation more than 1 year after the index PCI than those with preserved renal function (p < 0.001). Among patients with advanced renal dysfunction who underwent elective PCI, 34.1% showed renal dysfunction progression at 1 year. The decrease in renal function was not observed at 1 month but after 6 months of the index PCI in patients with renal dysfunction progression. Furthermore, patients with renal dysfunction progression had poorer long-term renal outcomes.
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21
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Kuźma Ł, Małyszko J, Kurasz A, Niwińska MM, Zalewska-Adamiec M, Bachórzewska-Gajewska H, Dobrzycki S. Impact of renal function on patients with acute coronary syndromes: 15,593 patient-years study. Ren Fail 2020; 42:881-889. [PMID: 32862755 PMCID: PMC7472470 DOI: 10.1080/0886022x.2020.1810069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Coexistence of chronic kidney disease (CKD) in the case of acute coronary syndromes (ACS) significantly worsens the outcomes. Aim The aim of our study was to assess renal function impact on mortality among patients with ACS. Materials and methods The study was based on records of 21,985 patients hospitalized in the Medical University of Bialystok in 2009–2015. Inclusion criteria were ACS. Exclusion criteria were: death within 24 h of admission, eGFR <15 ml/min/1.73 m2, hemodialysis. Mean observation time was 2296 days. Results Criteria were met by 2213 patients. CKD occurred in 24.1% (N = 533) and more often affected those with NSTEMI (26.2 (337) vs. 21.2 (196), p = .006). STEMI patients had higher incidence of post-contrast acute kidney injury (PC-AKI) (5 (46) vs. 4.1 (53), p < .001). During the study, 705 people died (31.9%), more often with NSTEMI (33.2% (428) vs. 29.95% (277), p < .001). However, from a group of patients suffering from PC-AKI 57.6% died. The risk of PC-AKI increased with creatinine concentration (RR: 2.990, 95%CI: 1.567–5.721, p < .001), occurrence of diabetes mellitus (RR: 2.143, 95%CI: 1.029–4.463, p = .042), atrial fibrillation (RR: 2.289, 95%CI: 1.056–4.959, p = .036). Risk of death was greater with an increase in postprocedural creatinine concentration (RR: 2.254, 95%CI: 1.481–3.424, p < .001). Conclusion PC-AKI is a major complication in patients with ACS, occurs more frequently in STEMI and may be a prognostic marker of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). More attention should be given to the prevention and diagnosis of PC-AKI but necessary PCI should not be withheld in fear of PC-AKI.
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Affiliation(s)
- Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Jolanta Małyszko
- Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Marta Maria Niwińska
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | | | - Hanna Bachórzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland.,Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
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22
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Venturi G, Pighi M, Pesarini G, Ferrero V, Lunardi M, Castaldi G, Setti M, Benini A, Scarsini R, Ribichini FL. Contrast-Induced Acute Kidney Injury in Patients Undergoing TAVI Compared With Coronary Interventions. J Am Heart Assoc 2020; 9:e017194. [PMID: 32787652 PMCID: PMC7660800 DOI: 10.1161/jaha.120.017194] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Differences in the impact of contrast medium on the development of contrast-induced acute kidney injury (CI-AKI) in patients undergoing transcatheter aortic valve implantation (TAVI) or a coronary angiography/percutaneous coronary intervention (CA/PCI) have not been previously investigated. Methods and Results Patients treated with TAVI or elective CA/PCI were retrospectively analyzed in terms of baseline and procedural characteristics, including preprocedural and postprocedural kidney function. CI-AKI was defined as a relative increase in serum creatinine concentration of at least 0.3 mg/dL within 72 hours of contrast-medium administration compared with baseline. The incidence of CI-AKI in the TAVI versus CA/PCI group was compared. After the exclusion of patients in dialysis and emergency procedures, 977 patients were analyzed; there were 489 patients who had undergone TAVI (50.1%) and 488 patients who had undergone CA/PCI (49.9%). Patients treated by TAVI were older, presenting a higher rate of anemia and chronic kidney disease (P<0.001 for all comparisons). Consistently, they also had a significantly lower glomerular filtration rate and higher serum creatinine concentration (P<0.001 for all). However, the occurrence of CI-AKI was significantly lower in these patients compared with patients treated by a CA/PCI (6.7% versus 14.5%, P<0.001). At multivariate analysis, the TAVI procedure had an independent protective effect on CI-AKI incidence among total population (odds ratio, 0.334; 95% CI, 0.193-0.579; P<0.001). This observation was confirmed after propensity score matching among 360 patients (180 by TAVI and 180 by CA/PCI; P=0.002). Conclusions CI-AKI occurred less frequently in patients undergoing TAVI than in patients undergoing a CA/PCI, despite a worse-risk profile. The impact of contrast administration on kidney function in patients who had undergone TAVI may be better tolerated because of the hemodynamic changes following aortic valve replacement.
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Affiliation(s)
- Gabriele Venturi
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Michele Pighi
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Gabriele Pesarini
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Valeria Ferrero
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Mattia Lunardi
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Gianluca Castaldi
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Martina Setti
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Annachiara Benini
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Roberto Scarsini
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Flavio L Ribichini
- Division of Cardiology Department of Medicine University of Verona Italy
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23
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Benini A, Scarsini R, Pesarini G, Pighi M, Ferrero V, Gambaro A, Piccoli A, Marin F, Inciardi RM, Gambaro G, Lupo A, Ribichini F. Early Small Creatinine Shift Predicts Contrast-Induced Acute Kidney Injury and Persistent Renal Damage after Percutaneous Coronary Procedures. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:305-311. [DOI: 10.1016/j.carrev.2019.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 12/13/2022]
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24
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Weisbord SD, Palevsky PM, Kaufman JS, Wu H, Androsenko M, Ferguson RE, Parikh CR, Bhatt DL, Gallagher M. Contrast-Associated Acute Kidney Injury and Serious Adverse Outcomes Following Angiography. J Am Coll Cardiol 2020; 75:1311-1320. [DOI: 10.1016/j.jacc.2020.01.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/17/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
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25
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Kurogi K, Ishii M, Sakamoto K, Komaki S, Marume K, Kusaka H, Yamamoto N, Arima Y, Yamamoto E, Kaikita K, Tsujita K. Persistent Renal Dysfunction in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction. J Am Heart Assoc 2019; 8:e014096. [PMID: 31766973 PMCID: PMC6912980 DOI: 10.1161/jaha.119.014096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The long-term prognosis of patients with acute myocardial infarction who develop persistent renal dysfunction (RD) remains unclear. We investigated risk factors and prognostic implications of persistent RD after contrast-induced nephropathy (CIN) in patients with acute myocardial infarction after primary percutaneous coronary intervention. Methods and Results We enrolled 952 consecutive patients who underwent primary percutaneous coronary intervention for acute myocardial infarction. CIN was defined as an increase in serum creatinine levels ≥0.5 mg/dL or ≥25% from baseline within 72 hours after percutaneous coronary intervention. Persistent RD was defined as residual impairment of renal function over 2 weeks, and transient RD was defined as recovery of renal function within 2 weeks, after CIN. The overall incidence of CIN was 8.8% and that of persistent CIN was 3.1%. A receiver-operator characteristic curve showed that the optimal cutoff value of the contrast volume/baseline estimated glomerular filtration rate ratio for persistent CIN was 3.45. In multivariable logistic analysis, a contrast volume/baseline estimated glomerular filtration rate >3.45 was an independent correlate of persistent RD. At 3 years, the incidence of death was significantly higher in patients with persistent RD than in those with transient RD (P=0.001) and in those without CIN (P<0.001). Cox regression analysis showed that persistent RD (hazard ratio, 4.99; 95% CI, 2.30-10.8; P<0.001) was a significant risk factor for mortality. A similar trend was observed for the combined end points, which included mortality, hemodialysis, stroke, and acute myocardial infarction. Conclusions Persistent RD, but not transient RD, is independently associated with long-term mortality. A contrast volume/baseline estimated glomerular filtration rate >3.45 is an independent predictor of persistent RD.
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Affiliation(s)
- Kazumasa Kurogi
- Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki Japan
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Soichi Komaki
- Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki Japan
| | - Kyohei Marume
- Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki Japan
| | - Hiroaki Kusaka
- Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki Japan
| | - Nobuyasu Yamamoto
- Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
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26
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Ribitsch W, Horina JH, Quehenberger F, Rosenkranz AR, Schilcher G. Contrast Induced Acute Kidney Injury and its Impact on Mid-Term Kidney Function, Cardiovascular Events and Mortality. Sci Rep 2019; 9:16896. [PMID: 31729409 PMCID: PMC6858434 DOI: 10.1038/s41598-019-53040-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 10/22/2019] [Indexed: 11/18/2022] Open
Abstract
The existence and clinical relevance of contrast induced acute kidney injury (CI-AKI) is still heavily debated and angiographic procedures are often withheld in fear of CI-AKI, especially in CKD-patients. We investigated the incidence of CI-AKI in cardiovascular high risk patients undergoing intra-arterial angiography and its impact on mid-term kidney function, cardiovascular events and mortality. We conducted a prospective observational trial on patients undergoing planned intra-arterial angiographic procedures. All subjects received standardized intravenous hydration prior to contrast application. CI-AKI was defined according to a ≥25% increase of creatinine from baseline to either 24hrs or 48hrs after angiography. Plasma creatinine and eGFR were recorded from the institutional medical record system one and three months after hospital discharge. Patients were followed up for two years to investigate the long term effects of CI-AKI on cardiovascular events and mortality. We studied 706 (317 female) patients with a mean eGFR of 52.0 ± 15 ml·min−1·1.73 m−2. The incidence of CI-AKI was 10.2% (72 patients). In 94 (13.3%) patients serum creatinine decreased ≥25% either 24 or 48 hours after angiography. Patients with CI-AKI had a lower creatinine and a higher eGFR at baseline, but no other independent predictors of CI-AKI could be identified. Kidney function was not different between both groups one and three months after discharge. After a two year follow up the overall incidence of cardiovascular events was 56.5% in the CI-AKI group and 58.8% in the Non CI-AKI group (p = 0.8), the incidence of myocardial infarctions, however, was higher in CI-AKI-patients. Overall survival was also not different between patients with CI-AKI (88.6%) and without CI-AKI (84.7%, p = 0.48). The occurrence of CI-AKI did not have any negative impact on mid-term kidney function, the incidence of cardiovascular events and mortality. Considerable fluctuations of serum creatinine interfere with the presumed diagnosis of CI-AKI. Necessary angiographic procedures should not be withheld in fear of CI-AKI.
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Affiliation(s)
- Werner Ribitsch
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria.
| | - Joerg H Horina
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Franz Quehenberger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Alexander R Rosenkranz
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Gernot Schilcher
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria.,Intensive Care Unit, Department of Internal Medicine, MUG, Graz, Austria
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27
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Nishida M, Kubo S, Morishita Y, Nishikawa K, Ikeda K, Itoi T, Hosoi H. Kidney injury biomarkers after cardiac angiography in children with congenital heart disease. CONGENIT HEART DIS 2019; 14:1087-1093. [PMID: 31605509 DOI: 10.1111/chd.12853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/26/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aims to investigate the changes in renal function and levels of urinary biomarkers before and after cardiac angiography in children with congenital heart disease (CHD). SETTING Children with CHD are at a risk for kidney injury during contrast exposure in cardiac angiography. OUTCOME MEASURES We measured urinary protein, albumin, N-acetyl-β-D-glucosaminidase (NAG), β2-microglobulin (BMG), and liver-type fatty acid-binding protein (L-FABP) levels, as well as serum creatinine and cystatin C levels, before and after cardiac angiography in 33 children with CHD. RESULTS No significant decrease was noted in either the creatinine-based or cystatin C-based estimated glomerular filtration rate at 24 hours after angiography compared with that before angiography. Urinary protein, NAG, BMG, and L-FABP levels were significantly increased at 24 hours after angiography, all of which returned to baseline levels at more than 7 days after angiography. An increase in urinary level of protein, albumin, NAG, or BMG was mostly associated with increased urinary L-FABP level. An increase in both urinary BMG and L-FABP, but not that in urinary L-FABP alone, was associated with increased levels of urinary protein and NAG, as well as the greater dose of contrast media. CONCLUSIONS Transient increases of kidney injury biomarkers following cardiac angiography are not necessarily associated with the impairment of renal function in a short time period; however, the increase in urinary protein, albumin, NAG, or BMG level may indicate greater stresses to the kidneys than the increase in urinary L-FABP alone in children with CHD.
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Affiliation(s)
- Masashi Nishida
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shingo Kubo
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuma Morishita
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kosuke Nishikawa
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuyuki Ikeda
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiyuki Itoi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hajime Hosoi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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28
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Costanzo P, Džavík V. Coronary Revascularization in Patients With Advanced Chronic Kidney Disease. Can J Cardiol 2019; 35:1002-1014. [DOI: 10.1016/j.cjca.2019.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/10/2019] [Accepted: 02/25/2019] [Indexed: 12/31/2022] Open
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29
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Yang Y, George KC, Luo R, Cheng Y, Shang W, Ge S, Xu G. Contrast-induced acute kidney injury and adverse clinical outcomes risk in acute coronary syndrome patients undergoing percutaneous coronary intervention: a meta-analysis. BMC Nephrol 2018; 19:374. [PMID: 30577763 PMCID: PMC6303898 DOI: 10.1186/s12882-018-1161-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 11/28/2018] [Indexed: 01/20/2023] Open
Abstract
Background Recent studies have shown associations between contrast-induced acute kidney injury (CI-AKI) and increased risk of adverse clinical outcomes in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI); however, the estimates are inconsistent and vary widely. Therefore, this meta-analysis aimed to evaluate the precise associations between CI-AKI and adverse clinical consequences in patients undergoing PCI for ACS. Methods EMBASE, PubMed, Web of Science™ and Cochrane Library databases were systematically searched from inception to December 16, 2016 for cohort studies assessing the association between CI-AKI and any adverse clinical outcomes in ACS patients treated with PCI. The results were demonstrated as pooled risk ratios (RRs) with 95% confidence intervals (CI). Heterogeneity was explored by subgroup analyses. Results We identified 1857 articles in electronic search, of which 22 (n = 32,781) were included. Our meta-analysis revealed that in ACS patients undergoing PCI, CI-AKI significantly increased the risk of adverse clinical outcomes including all-cause mortality (18 studies; n = 28,367; RR = 3.16, 95% CI 2.52–3.97; I2 = 56.9%), short-term all-cause mortality (9 studies; n = 13,895; RR = 5.55, 95% CI 3.53–8.73; I2 = 60.1%), major adverse cardiac events (7 studies; n = 19,841; RR = 1.49, 95% CI: 1.34–1.65; I2 = 0), major adverse cardiovascular and cerebrovascular events (3 studies; n = 2768; RR = 1.86, 95% CI: 1.42–2.43; I2 = 0) and stent restenosis (3 studies; n = 130,678; RR = 1.50, 95% CI: 1.24–1.81; I2 = 0), respectively. Subgroup analyses revealed that the studies with prospective cohort design, larger sample size and lower prevalence of CI-AKI might have higher short-term all-cause mortality risk. Conclusions CI-AKI may be a prognostic marker of adverse outcomes in ACS patients undergoing PCI. More attention should be paid to the diagnosis and management of CI-AKI. Electronic supplementary material The online version of this article (10.1186/s12882-018-1161-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yi Yang
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Kaisha C George
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Ran Luo
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Yichun Cheng
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Weifeng Shang
- Department of Nephrology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430000, People's Republic of China
| | - Shuwang Ge
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China.
| | - Gang Xu
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
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30
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Wyler von Ballmoos M, Likosky DS, Rezaee M, Lobdell K, Alam S, Parker D, Owens S, Thiessen-Philbrook H, MacKenzie T, Brown JR. Elevated preoperative Galectin-3 is associated with acute kidney injury after cardiac surgery. BMC Nephrol 2018; 19:280. [PMID: 30342486 PMCID: PMC6195960 DOI: 10.1186/s12882-018-1093-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/09/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Previous research suggests that novel biomarkers may be used to identify patients at increased risk of acute kidney injury following cardiac surgery. The purpose of this study was to evaluate the relationship between preoperative levels of circulating Galectin-3 (Gal-3) and acute kidney injury after cardiac surgery. METHODS Preoperative serum Gal-3 was measured in 1498 patients who underwent coronary artery bypass graft (CABG) surgery and/or valve surgery as part of the Northern New England Biomarker Study between 2004 and 2007. Preoperative Gal-3 levels were measured using multiplex assays and grouped into terciles. Univariate and multinomial logistic regression was used to assess the predictive ability of Gal-3 terciles and AKI occurrence and severity. RESULTS Before adjustment, patients in the highest tercile of Gal-3 had a 2.86-greater odds of developing postoperative KDIGO Stage 2 or 3 (p < 0.001) and 1.70-greater odds of developing KDIGO Stage 1 (p = < 0.001), compared to the first tercile. After adjustment, patients in the highest tercile had 2.95-greater odds of developing KDIGO Stage 2 or 3 (p < 0.001) and 1.71-increased odds of developing KDIGO Stage 1 (p = 0.001), compared to the first tercile. Compared to the base model, the addition of Gal-3 terciles improved discriminatory power compared to without Gal-3 terciles (test of equality = 0.042). CONCLUSION Elevated preoperative Gal-3 levels significantly improves predictive ability over existing clinical models for postoperative AKI and may be used to augment risk information for patients at the highest risk of developing AKI and AKI severity after cardiac surgery.
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Affiliation(s)
| | - Donald S. Likosky
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA
- Section of Health Services Research and Quality, Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI USA
| | - Michael Rezaee
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | | | - Shama Alam
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
| | - Devin Parker
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
| | - Sherry Owens
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
| | | | - Todd MacKenzie
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
- Department of Biomedical Data Science, HB 7505 Dartmouth-Hitchcock Medical Center, Lebanon, NH NH 03756 USA
| | - Jeremiah R. Brown
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
- Department of Biomedical Data Science, HB 7505 Dartmouth-Hitchcock Medical Center, Lebanon, NH NH 03756 USA
- Department of Epidemiology, Geisel School of Medicine, Lebanon, NH USA
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31
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Helgason D, Long TE, Helgadottir S, Palsson R, Sigurdsson GH, Gudbjartsson T, Indridason OS, Gudmundsdottir IJ, Sigurdsson MI. Acute kidney injury following coronary angiography: a nationwide study of incidence, risk factors and long-term outcomes. J Nephrol 2018; 31:721-730. [DOI: 10.1007/s40620-018-0534-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/31/2018] [Indexed: 02/06/2023]
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32
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Li S, Wang L, Liu Y, Hu Q. Preventive effect of nicorandil on contrast-induced nephropathy: a meta-analysis of randomised controlled trials. Intern Med J 2018; 48:957-963. [PMID: 29740934 DOI: 10.1111/imj.13962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 12/31/2017] [Accepted: 04/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Shuang Li
- Department of Pharmacy; LinYi Central Hospital; Linyi China
| | - Lin Wang
- Department of Pain Treatment; LinYi Central Hospital; Linyi China
| | - Yucai Liu
- Department of Pharmacy; LinYi Central Hospital; Linyi China
| | - Qiang Hu
- Department of Radiology; LinYi Central Hospital; Linyi China
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33
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Lim YM, Moon JY, Min D, Kim SH, Yang WI, Kim WJ, Sung JH, Kim IJ, Lim SW, Cha DH. Serial measurements of neutrophil gelatinase-associated lipocalin: prognostic value in patients with ST-segment elevation myocardial infarction treated with a primary percutaneous coronary intervention. Coron Artery Dis 2018; 28:690-696. [PMID: 28737526 DOI: 10.1097/mca.0000000000000542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND There are no previous data on serial changes in neutrophil gelatinase-associated lipocalin (NGAL) levels in ST-segment elevation myocardial infarction (STEMI) patients before and after a primary percutaneous coronary intervention (pPCI). The aim of the present study was to evaluate the prognostic value of serial NGAL measurements in patients with STEMI treated by pPCI. MATERIALS AND METHODS We identified 169 STEMI patients who underwent pPCI within 12 h of symptom onset and had plasma NGAL measurements before (pre-NGAL) and 6 h after (post-NGAL) pPCI. The primary endpoint was 30-day all-cause mortality, including cardiac death, whereas the secondary endpoint was the change in NGAL levels from before to after pPCI. RESULTS The mean pre-NGAL and post-NGAL levels were 109.2±76.1 and 93.3±83.8 ng/ml, respectively. Thirty-day mortality occurred in 12 (7.1%) patients. In terms of changes in serial NGAL levels, post-NGAL levels were decreased in 132 (79%) patients. Patients with elevated post-NGAL levels showed increased mortality compared with patients with decreased post-NGAL levels (P=0.005). Multivariate analyses indicated that old age and high post-NGAL levels were independent risk factors for 30-day mortality. CONCLUSION In a large percentage of STEMI patients, plasma post-pPCI NGAL levels were decreased compared with pre-pPCI NGAL levels, even with the administration of potentially nephrotoxic contrast medium. Post-NGAL levels seemed to be superior to pre-NGAL levels for the prediction of 30-day mortality outcome.
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Affiliation(s)
- Yeong-Min Lim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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34
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The EUROpean and Chinese cardiac and renal Remote Ischemic Preconditioning Study (EURO-CRIPS CardioGroup I): A randomized controlled trial. Int J Cardiol 2018; 257:1-6. [PMID: 29506674 DOI: 10.1016/j.ijcard.2017.12.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 02/08/2023]
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35
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McCullough PA, David G, Todoran TM, Brilakis ES, Ryan MP, Gunnarsson C. Iso-osmolar contrast media and adverse renal and cardiac events after percutaneous cardiovascular intervention. J Comp Eff Res 2018; 7:331-341. [DOI: 10.2217/cer-2017-0052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess the relationship between type of contrast media (CM), iso-osmolar contrast media (IOCM) or low-osmolar contrast media (LOCM), and major adverse renal and cardiovascular events (MARCE). Materials & methods: Coronary or peripheral angioplasty visits were stratified into CM cohorts: IOCM or LOCM. Multivariable regression analysis used hospital fixed effects to assess the relationship between MARCE events and type of CM. Results: Among 333,533 visits (357 hospitals), the incidence of MARCE was 7.41%. After controlling for observable and unobservable time invariant within-hospital characteristics, administration of IOCM versus LOCM was associated with a 0.69% absolute and 9.32% relative risk reduction in MARCE rate. Conclusion: Our study indicates that as compared with LOCM, IOCM may be associated with reduction of MARCE events in coronary or peripheral angioplasty patients.
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Affiliation(s)
- Peter A McCullough
- Baylor University Medical Center, Dallas, TX; Baylor Heart & Vascular Institute, Dallas, TX; Baylor Jack & Jane Hamilton Heart & Vascular Hospital, 621 N Hall St #H030, Dallas, TX 75226; Texas A&M Health Science Center College of Medicine, Dallas Campus, Dallas TX, USA
| | - Guy David
- Wharton School, University of Pennsylvania, 202 Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA 19104, USA
| | - Thomas M Todoran
- Medical University of South Carolina, 25 Courtenay Drive MSC 592, Charleston, SC 29425, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute & University of Texas Southwestern Medical Center, 920 E 28th St #300, Minneapolis, MN 55407, USA
| | - Michael P Ryan
- CTI Clinical Trial & Consulting Services, 100 E RiverCenter Blvd, Covington, KY 41011, USA
| | - Candace Gunnarsson
- CTI Clinical Trial & Consulting Services, 100 E RiverCenter Blvd, Covington, KY 41011, USA
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36
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Nagayama Y, Tanoue S, Tsuji A, Urata J, Furusawa M, Oda S, Nakaura T, Utsunomiya D, Yoshida E, Yoshida M, Kidoh M, Tateishi M, Yamashita Y. Application of 80-kVp scan and raw data-based iterative reconstruction for reduced iodine load abdominal-pelvic CT in patients at risk of contrast-induced nephropathy referred for oncological assessment: effects on radiation dose, image quality and renal function. Br J Radiol 2018; 91:20170632. [PMID: 29470108 DOI: 10.1259/bjr.20170632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the image quality, radiation dose, and renal safety of contrast medium (CM)-reduced abdominal-pelvic CT combining 80-kVp and sinogram-affirmed iterative reconstruction (SAFIRE) in patients with renal dysfunction for oncological assessment. METHODS We included 45 patients with renal dysfunction (estimated glomerular filtration rate <45 ml per min per 1.73 m2) who underwent reduced-CM abdominal-pelvic CT (360 mgI kg-1, 80-kVp, SAFIRE) for oncological assessment. Another 45 patients without renal dysfunction (estimated glomerular filtration rate >60 ml per lmin per 1.73 m2) who underwent standard oncological abdominal-pelvic CT (600 mgI kg-1, 120-kVp, filtered-back projection) were included as controls. CT attenuation, image noise, and contrast-to-noise ratio (CNR) were compared. Two observers performed subjective image analysis on a 4-point scale. Size-specific dose estimate and renal function 1-3 months after CT were measured. RESULTS The size-specific dose estimate and iodine load of 80-kVp protocol were 32 and 41%,, respectively, lower than of 120-kVp protocol (p < 0.01). CT attenuation and contrast-to-noise ratio of parenchymal organs and vessels in 80-kVp images were significantly better than those of 120-kVp images (p < 0.05). There were no significant differences in quantitative or qualitative image noise or subjective overall quality (p > 0.05). No significant kidney injury associated with CM administration was observed. CONCLUSION 80-kVp abdominal-pelvic CT with SAFIRE yields diagnostic image quality in oncology patients with renal dysfunction under substantially reduced iodine and radiation dose without renal safety concerns. Advances in knowledge: Using 80-kVp and SAFIRE allows for 40% iodine load and 32% radiation dose reduction for abdominal-pelvic CT without compromising image quality and renal function in oncology patients at risk of contrast-induced nephropathy.
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Affiliation(s)
- Yasunori Nagayama
- 1 Department of Radiology, Kumamoto City Hospital , Kumamoto , Japan.,2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Shota Tanoue
- 1 Department of Radiology, Kumamoto City Hospital , Kumamoto , Japan.,2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Akinori Tsuji
- 1 Department of Radiology, Kumamoto City Hospital , Kumamoto , Japan
| | - Joji Urata
- 1 Department of Radiology, Kumamoto City Hospital , Kumamoto , Japan
| | | | - Seitaro Oda
- 2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Takeshi Nakaura
- 2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Daisuke Utsunomiya
- 2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Eri Yoshida
- 1 Department of Radiology, Kumamoto City Hospital , Kumamoto , Japan.,2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Morikatsu Yoshida
- 2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Masafumi Kidoh
- 2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Machiko Tateishi
- 1 Department of Radiology, Kumamoto City Hospital , Kumamoto , Japan.,2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Yasuyuki Yamashita
- 2 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
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37
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Lee HG, Kim WK, Yeon JY, Kim JS, Kim KH, Jeon P, Hong SC. Contrast-Induced Acute Kidney Injury after Coil Embolization for Aneurysmal Subarachnoid Hemorrhage. Yonsei Med J 2018; 59:107-112. [PMID: 29214784 PMCID: PMC5725346 DOI: 10.3349/ymj.2018.59.1.107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Contrast-induced acute kidney injury (CI-AKI) is associated with poor outcomes after percutaneous coronary intervention. However, CI-AKI has rarely been evaluated within the neurovascular field. The aim of this study was to investigate the incidence and clinical implication of CI-AKI after coil embolization in patients with an aneurysmal subarachnoid hemorrhage (aSAH). MATERIALS AND METHODS Between January 2005 and March 2016, 192 patients who underwent coil embolization were enrolled in this study. CI-AKI was defined as an increase from baseline serum creatinine concentration of >25% or >0.5 mg/dL within 72 hours after coil embolization. A poor clinical outcome was defined as a score of ≥3 on the modified Rankin Scale at one-year post-treatment. RESULTS A total of 16 patients (8.3%) died as a result of medical problems within one year. CI-AKI was identified in 14 patients (7.3%). Prominent risk factors for one-year mortality included CI-AKI [odds ratio (OR): 16.856; 95% confidence interval (CI): 3.437-82.664] and an initial Glasgow Coma Scale (GCS) score ≤8 (OR: 5.565; 95% CI: 1.703-18.184). A poor clinical outcome was associated with old age (≥65 years) (OR: 7.921; 95% CI: 2.977-21.076), CI-AKI (OR: 11.281; 95% CI: 2.138-59.525), an initial GCS score ≤8 (OR 31.02; 95% CI, 10.669-90.187), and a ruptured aneurysm (p=0.016, OR: 4.278) in posterior circulation. CONCLUSION CI-AKI seems to be an independent predictor of the overall outcomes of aSAH after endovascular treatment.
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Affiliation(s)
- Hyun Goo Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Ki Kim
- Department of Neurosurgery, Dongkang Medical Center, Ulsan, Korea
| | - Je Young Yeon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Soo Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Ha Kim
- Department of Radiology, Division of Interventional Neuroradiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyoung Jeon
- Department of Radiology, Division of Interventional Neuroradiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Chyul Hong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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38
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Scharnweber T, Alhilali L, Fakhran S. Contrast-Induced Acute Kidney Injury: Pathophysiology, Manifestations, Prevention, and Management. Magn Reson Imaging Clin N Am 2017; 25:743-753. [PMID: 28964464 DOI: 10.1016/j.mric.2017.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Contrast-induced acute kidney injury is a phenomenon that has been extensively studied throughout the years. There is a large volume of literature documenting this risk, and most radiology departments and radiologists use this information when making decisions regarding contrast administration. A review of the current information on the topic of contrast-induced acute kidney injury is necessary to ensure that the risks of intravenous contrast are properly weighed against the benefits of a contrast-enhanced computed tomography scan.
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Affiliation(s)
- Travis Scharnweber
- Department of Neuroradiology, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, AZ 85013, USA.
| | - Lea Alhilali
- Department of Neuroradiology, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, AZ 85013, USA
| | - Saeed Fakhran
- Department of Neuroradiology, East Valley Diagnostic Imaging, Banner Health and Hospital System, 1201 S Alma School Road, Suite 14000, Mesa, AZ 85210, USA
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39
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Briguori C, Quintavalle C, De Micco F, Visconti G, Di Palma V, Napolitano G, Focaccio A, Condorelli G. Persistent serum creatinine increase following contrast-induced acute kidney injury. Catheter Cardiovasc Interv 2017; 91:1185-1191. [DOI: 10.1002/ccd.27239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/22/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Carlo Briguori
- Interventional Cardiology Unit, Clinica Mediterranea; Naples Italy
| | - Cristina Quintavalle
- Department of Molecular Medicine and Medical Biotechnologies; “Federico II” University of Naples, IEOS; CNR Naples Italy
| | | | | | - Vito Di Palma
- Interventional Cardiology Unit, Clinica Mediterranea; Naples Italy
| | - Giovanni Napolitano
- Department of Cardiology; U.O. Cardiologia, Ospedale San Giuliano; Giuliano Italy
| | - Amelia Focaccio
- Interventional Cardiology Unit, Clinica Mediterranea; Naples Italy
| | - Gerolama Condorelli
- Department of Molecular Medicine and Medical Biotechnologies; “Federico II” University of Naples, IEOS; CNR Naples Italy
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40
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Shah M, Gajanana D, Wheeler DS, Punjabi C, Maludum O, Mezue K, Lerma EV, Ardati A, Romero-Corral A, Witzke C, Rangaswami J. Effects of staged versus ad hoc percutaneous coronary interventions on renal function—Is there a benefit to staging? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:344-348. [DOI: 10.1016/j.carrev.2017.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 02/17/2017] [Accepted: 02/23/2017] [Indexed: 11/25/2022]
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41
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Valle JA, McCoy LA, Maddox TM, Rumsfeld JS, Ho PM, Casserly IP, Nallamothu BK, Roe MT, Tsai TT, Messenger JC. Longitudinal Risk of Adverse Events in Patients With Acute Kidney Injury After Percutaneous Coronary Intervention: Insights From the National Cardiovascular Data Registry. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004439. [PMID: 28404621 DOI: 10.1161/circinterventions.116.004439] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 03/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) remains a common complication after percutaneous coronary intervention (PCI) and is associated with adverse in-hospital patient outcomes. The incidence of adverse events after hospital discharge in patients having post-PCI AKI is poorly defined, and the relationship between AKI and outcomes after hospital discharge remains understudied. METHODS AND RESULTS Using the National Cardiovascular Data Registry CathPCI registry, we assessed the incidence of AKI among Medicare beneficiaries after PCI from 2004 to 2009 and subsequent post-discharge adverse events at 1 year. AKI was defined using Acute Kidney Injury Network (AKIN) criteria. Adverse events included death, myocardial infarction, bleeding, and recurrent kidney injury. Using Cox methods, we determined the relationship between in-hospital AKI and risk of post-discharge adverse events by AKIN stage. In a cohort of 453 475 elderly patients undergoing PCI, 39 850 developed AKI (8.8% overall; AKIN stage 1, 85.8%; AKIN 2/3, 14.2%). Compared with no AKI, in-hospital AKI was associated with higher post-discharge hazard of death, myocardial infarction, or bleeding (AKIN 1: hazard ratio [HR], 1.53; confidence interval [CI], 1.49-1.56 and AKIN 2/3: HR, 2.13; CI, 2.01-2.26), recurrent AKI (AKIN 1: HR, 1.70; CI, 1.64-1.76; AKIN 2/3: HR, 2.22; CI, 2.04-2.41), and AKI requiring dialysis (AKIN 1: HR, 2.59; CI, 2.29-2.92; AKIN 2/3: HR, 4.73; CI, 3.73-5.99). For each outcome, the highest incidence was within 30 days. CONCLUSIONS Post-PCI AKI is associated with increased risk of death, myocardial infarction, bleeding, and recurrent renal injury after discharge. Post-PCI AKI should be recognized as a significant risk factor not only for in-hospital adverse events but also after hospital discharge.
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Affiliation(s)
- Javier A Valle
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.).
| | - Lisa A McCoy
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Thomas M Maddox
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - John S Rumsfeld
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - P Michael Ho
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Ivan P Casserly
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Brahmajee K Nallamothu
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Matthew T Roe
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Thomas T Tsai
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - John C Messenger
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
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Lambert P, Chaisson K, Horton S, Petrin C, Marshall E, Bowden S, Scott L, Conley S, Stender J, Kent G, Hopkins E, Smith B, Nicholson A, Roy N, Homsted B, Downs C, Ross CS, Brown J. Reducing Acute Kidney Injury Due to Contrast Material: How Nurses Can Improve Patient Safety. Crit Care Nurse 2017; 37:13-26. [PMID: 28148611 PMCID: PMC5557383 DOI: 10.4037/ccn2017178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acute kidney injury due to contrast material occurs in 3% to 15% of the 2 million cardiac catheterizations done in the United States each year. OBJECTIVE To reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. METHODS Nurse leaders in the Northern New England Cardiovascular Disease Study Group, a 10-center quality improvement consortium in Maine, New Hampshire, and Vermont, formed a nursing task force to reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. Data were prospectively collected January 1, 2007, through June 30, 2012, on consecutive nonemergent patients (n = 20 147) undergoing percutaneous coronary interventions. RESULTS Compared with baseline rates, adjusted rates of acute kidney injury among the 10 centers were significantly reduced by 21% and by 28% in patients with baseline estimated glomerular filtration rate less than 60 mL/min per 1.73 m2. Key qualitative system factors associated with improvement included use of multidisciplinary teams, standardized fluid orders, use of an intravenous fluid bolus, patient education about oral hydration, and limiting the volume of contrast material. CONCLUSIONS Standardization of evidence-based best practices in nursing care may reduce the incidence of acute kidney injury due to contrast material.
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Affiliation(s)
- Peggy Lambert
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Kristine Chaisson
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Susan Horton
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Carmen Petrin
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Emily Marshall
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Sue Bowden
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Lynn Scott
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Sheila Conley
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Janette Stender
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Gertrude Kent
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Ellen Hopkins
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Brian Smith
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Anita Nicholson
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Nancy Roy
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Brenda Homsted
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Cindy Downs
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
| | - Cathy S Ross
- Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire
- Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine
- Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center
- Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center
- Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine
- Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire
- Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine
- Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center
- Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project
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Smits NC, Kobayashi T, Srivastava PK, Skopelja S, Ivy JA, Elwood DJ, Stan RV, Tsongalis GJ, Sellke FW, Gross PL, Cole MD, DeVries JT, Kaplan AV, Robb JF, Williams SM, Shworak NW. HS3ST1 genotype regulates antithrombin's inflammomodulatory tone and associates with atherosclerosis. Matrix Biol 2017; 63:69-90. [PMID: 28126521 DOI: 10.1016/j.matbio.2017.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 12/21/2022]
Abstract
The HS3ST1 gene controls endothelial cell production of HSAT+ - a form of heparan sulfate containing a specific pentasaccharide motif that binds the anticoagulant protein antithrombin (AT). HSAT+ has long been thought to act as an endogenous anticoagulant; however, coagulation was normal in Hs3st1-/- mice that have greatly reduced HSAT+ (HajMohammadi et al., 2003). This finding indicates that HSAT+ is not essential for AT's anticoagulant activity. To determine if HSAT+ is involved in AT's poorly understood inflammomodulatory activities, Hs3st1-/- and Hs3st1+/+ mice were subjected to a model of acute septic shock. Compared with Hs3st1+/+ mice, Hs3st1-/- mice were more susceptible to LPS-induced death due to an increased sensitivity to TNF. For Hs3st1+/+ mice, AT treatment reduced LPS-lethality, reduced leukocyte firm adhesion to endothelial cells, and dilated isolated coronary arterioles. Conversely, for Hs3st1-/- mice, AT induced the opposite effects. Thus, in the context of acute inflammation, HSAT+ selectively mediates AT's anti-inflammatory activity; in the absence of HSAT+, AT's pro-inflammatory effects predominate. To explore if the anti-inflammatory action of HSAT+ also protects against a chronic vascular-inflammatory disease, atherosclerosis, we conducted a human candidate-gene association study on >2000 coronary catheterization patients. Bioinformatic analysis of the HS3ST1 gene identified an intronic SNP, rs16881446, in a putative transcriptional regulatory region. The rs16881446G/G genotype independently associated with the severity of coronary artery disease and atherosclerotic cardiovascular events. In primary endothelial cells, the rs16881446G allele associated with reduced HS3ST1 expression. Together with the mouse data, this leads us to conclude that the HS3ST1 gene is required for AT's anti-inflammatory activity that appears to protect against acute and chronic inflammatory disorders.
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Affiliation(s)
- Nicole C Smits
- Section of Cardiology, Department of Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Takashi Kobayashi
- Section of Cardiology, Department of Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Pratyaksh K Srivastava
- Section of Cardiology, Department of Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Sladjana Skopelja
- Section of Cardiology, Department of Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Julianne A Ivy
- Section of Cardiology, Department of Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Dustin J Elwood
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Radu V Stan
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Gregory J Tsongalis
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Brown Medical School, Providence, RI, USA
| | - Peter L Gross
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Michael D Cole
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - James T DeVries
- Section of Cardiology, Department of Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Aaron V Kaplan
- Section of Cardiology, Department of Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - John F Robb
- Section of Cardiology, Department of Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Scott M Williams
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Nicholas W Shworak
- Section of Cardiology, Department of Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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Brown JR, Pearlman DM, Marshall EJ, Alam SS, MacKenzie TA, Recio-Mayoral A, Gomes VO, Kim B, Jensen LO, Mueller C, Maioli M, Solomon RJ. Meta-Analysis of Individual Patient Data of Sodium Bicarbonate and Sodium Chloride for All-Cause Mortality After Coronary Angiography. Am J Cardiol 2016; 118:1473-1479. [PMID: 27642111 PMCID: PMC6579735 DOI: 10.1016/j.amjcard.2016.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 12/22/2022]
Abstract
We sought to examine the relation between sodium bicarbonate prophylaxis for contrast-associated nephropathy (CAN) and mortality. We conducted an individual patient data meta-analysis from multiple randomized controlled trials. We obtained individual patient data sets for 7 of 10 eligible trials (2,292 of 2,764 participants). For the remaining 3 trials, time-to-event data were imputed based on follow-up periods described in their original reports. We included all trials that compared periprocedural intravenous sodium bicarbonate to periprocedural intravenous sodium chloride in patients undergoing coronary angiography or other intra-arterial interventions. Included trials were determined by consensus according to predefined eligibility criteria. The primary outcome was all-cause mortality hazard, defined as time from randomization to death. In 10 trials with a total of 2,764 participants, sodium bicarbonate was associated with lower mortality hazard than sodium chloride at 1 year (hazard ratio 0.61, 95% confidence interval [CI] 0.41 to 0.89, p = 0.011). Although periprocedural sodium bicarbonate was associated with a reduction in the incidence of CAN (relative risk 0.75, 95% CI 0.62 to 0.91, p = 0.003), there exists a statistically significant interaction between the effect on mortality and the occurrence of CAN (hazard ratio 5.65, 95% CI 3.58 to 8.92, p <0.001) for up to 1-year mortality. Periprocedural intravenous sodium bicarbonate seems to be associated with a reduction in long-term mortality in patients undergoing coronary angiography or other intra-arterial interventions.
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Affiliation(s)
- Jeremiah R Brown
- The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Medicine, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Community and Family Medicine, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
| | - Daniel M Pearlman
- The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Emily J Marshall
- The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Shama S Alam
- The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Todd A MacKenzie
- The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Medicine, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Community and Family Medicine, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | | | - Vitor O Gomes
- Hospital São Lucas, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bokyung Kim
- The Dartmouth Institute for Health Policy and Clinical Practice, Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Petersgraben, Switzerland
| | - Mauro Maioli
- Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy
| | - Richard J Solomon
- Fletcher Allen Health Care, University of Vermont School of Medicine, Burlington, Vermont
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Brown JR, Solomon RJ, Robey RB, Plomondon ME, Maddox TM, Marshall EJ, Nichols EL, Matheny ME, Tsai TT, Rumsfeld JS, Lee RE, Sarnak MJ. Chronic Kidney Disease Progression and Cardiovascular Outcomes Following Cardiac Catheterization-A Population-Controlled Study. J Am Heart Assoc 2016; 5:e003812. [PMID: 27742616 PMCID: PMC5121483 DOI: 10.1161/jaha.116.003812] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/06/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Studies of kidney disease associated with cardiac catheterization typically rely on billing records rather than laboratory data. We examined the associations between percutaneous coronary interventions, acute kidney injury, and chronic kidney disease progression using comprehensive Veterans Affairs clinical and laboratory databases. METHODS AND RESULTS Patients undergoing percutaneous coronary interventions between 2005 and 2010 (N=24 405) were identified in the Veterans Affairs Clinical Assessment, Reporting, and Tracking registry and examined for associated acute kidney injury and chronic kidney disease development or progression relative to 24 405 matched population controls. Secondary outcomes analyzed included dialysis, acute myocardial infarction, and mortality. The incidence of chronic kidney disease progression following percutaneous coronary interventions complicated by acute kidney injury, following uncomplicated coronary interventions, and in matched controls were 28.66, 11.15, and 6.81 per 100 person-years, respectively. Percutaneous coronary intervention also increased the likelihood of chronic kidney disease progression in both the presence and absence of acute injury relative to controls in adjusted analyses (hazard ratio [HR], 5.02 [95% CI, 4.68-5.39]; and HR, 1.76 [95% CI, 1.70-1.86]). Among patients with estimated glomerular filtration rate <60 mL/min per 1.73 m2, acute kidney injury increased the likelihood of disease progression by 8-fold. Similar results were observed for all secondary outcomes. CONCLUSIONS Acute kidney injury following percutaneous coronary intervention was associated with increased chronic kidney disease development and progression and mortality.
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Affiliation(s)
- Jeremiah R Brown
- The Dartmouth Institute for Health Policy and Clinical Practice and Section of Cardiology, Department of Medicine, Geisel School of Medicine, Lebanon, NH
| | - Richard J Solomon
- Section of Nephrology, Fletcher Allen Health Center, University of Vermont, Burlington, VT
| | - R Brooks Robey
- Section of Nephrology and Research and Development Service, White River Junction Veterans Affairs Medical Center, Veterans Administration, White River Junction, VT
| | - Meg E Plomondon
- VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, CO
| | - Thomas M Maddox
- VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, CO
| | - Emily J Marshall
- The Dartmouth Institute for Health Policy and Clinical Practice and Section of Cardiology, Department of Medicine, Geisel School of Medicine, Lebanon, NH
| | - Elizabeth L Nichols
- The Dartmouth Institute for Health Policy and Clinical Practice and Section of Cardiology, Department of Medicine, Geisel School of Medicine, Lebanon, NH
| | - Michael E Matheny
- Geriatrics Research, Education, and Clinical Care, Tennessee Valley Healthcare System, Veteran's Administration, Nashville, TN
| | - Thomas T Tsai
- VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, CO
| | - John S Rumsfeld
- VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, CO
| | - Richard E Lee
- Department of Veterans Affairs, Veterans Rural Health Resource Center - Eastern Region, White River Junction, VT
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
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Choe JC, Cha KS, Ahn J, Park JS, Lee HW, Oh JH, Kim JS, Choi JH, Park YH, Lee HC, Kim JH, Chun KJ, Hong TJ, Ahn Y, Jeong MH. Persistent Renal Dysfunction After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction. Angiology 2016; 68:159-167. [DOI: 10.1177/0003319716646680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We determined the incidence, predictors, and outcomes of persistent renal dysfunction (PRD) following percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Among 16 264 patients enrolled in a nationwide registry, we studied patients with AMI who had their estimated glomerular filtration rate at baseline and 1 month later (n = 3606). We used multivariate regression and propensity score (PS)-matched Cox proportional hazards to evaluate the association between PRD and outcomes. Persistent renal dysfunction occurred in 1333 (37%) patients. Significant PRD contributors included old age, low body mass index (BMI), hypertension, Killip class, and the extent of vessel disease. Persistent renal dysfunction was associated with an increased 1-year major adverse cardiac events (all-cause death, myocardial infarction, or revascularization) relative to no-PRD (entire cohort: 6.2% vs 4.5%, hazard ratio[HR] 1.63, 95% confidence interval [CI] 1.18-2.25, P = .003; PS-matched cohort: 7.2% vs 4.9%, HR 1.67, 95% CI 1.08-2.58, P = .022). In conclusion, PRD occurred in approximately one-third of patients with AMI following PCI. It was associated with old age, hypertension, low BMI, initial hemodynamic instability, and extent of vessel disease and was a predictor of worse outcomes at 1 year.
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Affiliation(s)
| | - Kwang Soo Cha
- Pusan National University Hospital, Busan, South Korea
| | - Jinhee Ahn
- Pusan National University Hospital, Busan, South Korea
| | - Jin Sup Park
- Pusan National University Hospital, Busan, South Korea
| | - Hye Won Lee
- Pusan National University Hospital, Busan, South Korea
| | - Jun-Hyok Oh
- Pusan National University Hospital, Busan, South Korea
| | - Jeong Su Kim
- Pusan National University Yangsan Hospital, Yangsan, South Korea
| | | | - Yong Hyun Park
- Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Han Cheol Lee
- Pusan National University Hospital, Busan, South Korea
| | - June Hong Kim
- Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Kook Jin Chun
- Pusan National University Yangsan Hospital, Yangsan, South Korea
| | | | - Youngkeun Ahn
- Chonnam National University Hospital, Gwangju, South Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, South Korea
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Maaniitty T, Stenström I, Uusitalo V, Ukkonen H, Kajander S, Bax JJ, Saraste A, Knuuti J. Incidence of persistent renal dysfunction after contrast enhanced coronary CT angiography in patients with suspected coronary artery disease. Int J Cardiovasc Imaging 2016; 32:1567-75. [PMID: 27405562 DOI: 10.1007/s10554-016-0935-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/05/2016] [Indexed: 01/08/2023]
Abstract
Contrast-induced nephropathy (CIN) is a potentially serious complication of contrast agents used in computed tomography angiography (CTA). The aim of this study was to evaluate whether persistent renal dysfunction occurs in patients undergoing coronary CTA for suspected stable coronary artery disease (CAD). From a cohort of 957 patients undergone coronary CTA, we identified 402 patients with plasma creatinine levels collected before and within 6 months after CTA. According to the definition of CIN, patients with a ≥25 % increase in plasma creatinine after CTA were evaluated. The post-CTA measurements in 402 patients (195 men, age 62.9 ± 9.3 years) were performed at a median of 99 days after CTA. On average, there was no change in plasma creatinine level between the pre- and post-CTA measurements (75.8 ± 16.0 and 75.7 ± 16.4 µmol/L, respectively; P = 0.63) but both increases and decreases were commonly detected. Fourteen (3.5 %) patients had a ≥25 % increase in plasma creatinine levels after CTA. A more detailed evaluation of these patients revealed that in 4 patients the increase was explained by other morbidities, whereas in 9 patients the creatinine level returned to the previous levels at later follow-up (median time to normalization: 311 days). Only in 1 (0.2 %) remaining patient, there was a persistent increase in plasma creatinine level, possibly related to the iodine contrast agent exposure. Alterations in plasma creatinine concentration occur frequently. Persistent renal dysfunction attributable to iodine contrast agent exposure is rare in patients referred to coronary CTA for suspected CAD.
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Affiliation(s)
- Teemu Maaniitty
- Turku PET Centre, Turku University Hospital, University of Turku, P.O. Box 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Iida Stenström
- Turku PET Centre, Turku University Hospital, University of Turku, P.O. Box 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Valtteri Uusitalo
- Turku PET Centre, Turku University Hospital, University of Turku, P.O. Box 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | | | - Sami Kajander
- Turku PET Centre, Turku University Hospital, University of Turku, P.O. Box 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital, University of Turku, P.O. Box 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland
- Heart Center, Turku University Hospital, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital, University of Turku, P.O. Box 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
- Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, Turku, Finland.
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Yazıcı S, Kırış T, Emre A, Ceylan US, Akyüz Ş, Uzun AO, Hacı R, Terzi S, Erdem A, Yeşilçimen K. Relation of contrast nephropathy to adverse events in pulmonary emboli patients diagnosed with contrast CT. Am J Emerg Med 2016; 34:1247-50. [DOI: 10.1016/j.ajem.2016.03.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/13/2016] [Accepted: 03/21/2016] [Indexed: 01/21/2023] Open
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Acute Kidney Injury Severity and Long-Term Readmission and Mortality After Cardiac Surgery. Ann Thorac Surg 2016; 102:1482-1489. [PMID: 27319985 DOI: 10.1016/j.athoracsur.2016.04.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/01/2016] [Accepted: 04/06/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication after cardiac surgery. While AKI severity is known to be associated with increased risk of short-term outcomes, its long-term impact is less well understood. METHODS Adult patients undergoing isolated coronary artery bypass graft surgery at eight centers were enrolled into the Northern New England biomarker registry (n = 1,610). Patients were excluded if they had renal failure (n = 15) or died during index admission (n = 38). Severity of AKI was defined using the Acute Kidney Injury Network (AKIN). We linked our cohort to national Medicare and state all-payer claims to ascertain readmissions and to the National Death Index to ascertain survival. Kaplan-Meier and multivariate Cox proportional hazards modeling was conducted for time to readmission and death over 5 years. RESULTS Within 5 years, 513 patients (33.8%) had AKI with AKIN stage 1 (29.9%) and stage 2 to 3 (3.9%). There were 620 readmissions (39.9%) and 370 deaths (23.8%). After adjustment, stage 1 AKI patients had a 31% increased risk of readmission (95% confidence interval [CI]: 1.10 to 1.57), whereas stage 2 or 3 patients had a 98% increased risk (95% CI: 1.41 to 2.78) compared with patients having no AKI. Relative to patients without AKI, stage 1 patients had a 56% increased risk of mortality (95% CI: 1.14 to 2.13), whereas stage 2 or 3 patients had a 3.5 times higher risk (95% CI: 2.16 to 5.60). CONCLUSIONS Severity of AKI using the AKIN stage criteria is associated with a significantly increased risk of 5-year readmission and mortality. Our findings suggest that efforts to reduce AKI in the perioperative period may have a significant long-term impact on patients and payers in reducing mortality and health care utilization.
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Hospital Mortality in the United States following Acute Kidney Injury. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4278579. [PMID: 27376083 PMCID: PMC4916271 DOI: 10.1155/2016/4278579] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/08/2016] [Indexed: 11/18/2022]
Abstract
Acute kidney injury (AKI) is a common reason for hospital admission and complication of many inpatient procedures. The temporal incidence of AKI and the association of AKI admissions with in-hospital mortality are a growing problem in the world today. In this review, we discuss the epidemiology of AKI and its association with in-hospital mortality in the United States. AKI has been growing at a rate of 14% per year since 2001. However, the in-hospital mortality associated with AKI has been on the decline starting with 21.9% in 2001 to 9.1 in 2011, even though the number of AKI-related in-hospital deaths increased almost twofold from 147,943 to 285,768 deaths. We discuss the importance of the 71% reduction in AKI-related mortality among hospitalized patients in the United States and draw on the discussion of whether or not this is a phenomenon of hospital billing (coding) or improvements to the management of AKI.
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