What is the clinical evidence from this study?

Study design: Cohort. Population: High-risk percutaneous coronary intervention (hrPCI) (n=470). Intervention: Acute kidney injury (AKI) vs. No acute kidney injury. Primary outcome: One-year mortality (HR 2.75, 95% CI 1.11-6.82).

What question did this study set out to answer?

This study aims to assess how acute kidney injury affects one-year survival after high-risk percutaneous coronary intervention and the potential protective role of Impella support.

April 1, 2026Open Access

Prognostic impact of acute kidney injury on one-year survival in patients undergoing high-risk PCI with Impella support

Resultado clave

Acute kidney injury following Impella-supported high-risk percutaneous coronary intervention independently predicted one-year mortality (HR 2.75), while upfront Impella use reduced expected AKI risk.

Puntos clave

This study aims to assess how acute kidney injury affects one-year survival after high-risk percutaneous coronary intervention and the potential protective role of Impella support.
Analyzed data from two cohorts: IMPELLA-PL group and Dresden group.
Defined acute kidney injury as a ≥ 0.5 mg/dL increase in serum creatinine within 72 hours.
Evaluated the impact of AKI on one-year mortality using hazard ratios.
Examined the association of Impella use and glomerular filtration rate with AKI incidence.
AKI occurred in 13.3% and 14.9% of patients in the IMPELLA-PL and Dresden groups, respectively.
AKI was an independent predictor of one-year mortality, with hazard ratios of 2.75 and 2.16 for derivation and validation cohorts, respectively.
Upfront Impella implantation and higher baseline glomerular filtration rate reduced AKI risk.
Significant adverse effects of AKI on long-term survival were noted primarily in males.

Diseño del estudio

Tipo

Cohort (n=470)

Multicéntrico

Sí

PICO estructurado

Does acute kidney injury impact one-year survival in patients undergoing high-risk PCI with Impella support?

Población

Patients undergoing high-risk percutaneous coronary intervention (hrPCI) with Impella support, excluding those with primary cardiogenic shock or undergoing chronic dialysis

Intervención

High-risk percutaneous coronary intervention (hrPCI) with Impella support

Resultado

One-year mortalityhard clinical

Acute kidney injury is a strong independent predictor of one-year mortality following Impella-supported high-risk PCI, though upfront Impella use is associated with a lower-than-predicted risk of developing AKI.

Resultado numérico

Estimación del efecto: HR 2.75 (95% CI 1.11-6.82)

Limitaciones

Observational design limits the establishment of a causal relationship between Impella use and reduced AKI incidence.
The Mehran score may overestimate the predicted risk of AKI in this study population.
Exclusion of patients with cardiogenic shock limits generalizability to broader high-risk populations.
Unmeasured confounders such as hydration protocols and operator technique may have influenced outcomes.
Observed sex differences in the prognostic impact of AKI are exploratory due to limited statistical power in the female group.
Baseline renal function was assessed using the MDRD equation instead of the currently recommended CKD-EPI formula.
Absence of prospectively predefined and uniformly applied standardized criteria for hrPCI may introduce selection bias.

Resumen

This multicenter study evaluated the prognostic impact of acute kidney injury (AKI) on one-year survival in patients undergoing Impella-supported high-risk percutaneous coronary intervention (hrPCI), and whether Impella use offers renal protection. A total of 470 patients from two independent cohorts were analyzed: the IMPELLA-PL group (n = 249, derivation cohort) and the Dresden group (n = 221, validation cohort). Patients with cardiogenic shock or chronic dialysis were not included. AKI—defined as a ≥ 0.5 mg/dL increase in serum creatinine within 72 h—occurred in 13.3% and 14.9% of patients, respectively, which was significantly lower than the predicted 26.1% risk based on the Mehran Risk Score. AKI was an independent predictor of one-year mortality in both the derivation (HR: 2.75; 95% CI: 1.11–6.82) and validation (HR: 2.16; 95% CI: 1.12–4.10) cohorts. Upfront Impella implantation and higher baseline glomerular filtration rate were independently associated with a reduced risk of AKI in both cohorts. The adverse effect of AKI on long-term survival was significant in males, but not in females. These findings indicate that although AKI remains a strong prognostic marker following hrPCI, early Impella support may mitigate this risk. The results also suggest potential sex-related differences in susceptibility to renal complications following complex coronary interventions.

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Cite This Study

Sacha et al. (Mon,) conducted a cohort in High-risk percutaneous coronary intervention (hrPCI) (n=470). Acute kidney injury (AKI) vs. No acute kidney injury was evaluated on One-year mortality (HR 2.75, 95% CI 1.11-6.82). Acute kidney injury following Impella-supported high-risk percutaneous coronary intervention independently predicted one-year mortality (HR 2.75), while upfront Impella use reduced expected AKI risk.

synapsesocial.com/papers/69ccb5d116edfba7beb87883 https://doi.org/https://doi.org/10.1038/s41598-026-44724-w

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