Heterogeneity in the Prognosis of Acute Kidney Injury Following Percutaneous Coronary Intervention

A cute kidney injury (AKI) affects 7% of patients who undergo percutaneous coronary intervention (PCI) and is associated with increased in-hospital and long-term mortality. 1Reducing rates of AKI has been a focus of quality improvement initiatives. 2 The National Cardiovascular Data Registry (NCDR) CathPCI registry reports risk-adjusted rates of AKI following PCI as a hospital performance metric.However, post-PCI AKI is currently measured as a binary event based on a serum creatinine (SCr) increase of ≥50% or ≥0.3 mg/dL. 3This approach has several shortcomings.An equal increase in SCr represents different degrees of decrease in estimated glomerular filtration rate for different baseline renal function.Further, the prognostic effect of an AKI event could vary based on the degree of AKI and on the patient's baseline renal function.In order to better characterize the prognostic implications of AKI with respect to baseline SCr, we assessed the association of AKI with 30-day all-cause mortality by levels of preprocedural baseline SCr and AKI severity using the NCDR CathPCI registry linked with Medicare claims. 4The area under the curve for the NCDR model was 0.85 for predicting 30-day mortality.