In-hospital AKI after PCI was associated with a higher 1-year post-discharge hazard of death, MI, or bleeding compared with no AKI (AKIN 1: HR 1.53; 95% CI 1.49-1.56).
Cohort (n=453,475)
Yes
Does in-hospital acute kidney injury after PCI increase the risk of post-discharge adverse events at 1 year in elderly patients?
Post-PCI acute kidney injury is a significant risk factor for long-term post-discharge adverse events, including death, myocardial infarction, bleeding, and recurrent renal injury.
Effect estimate: HR 1.53 (95% CI 1.49-1.56)
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.
Valle et al. (Sat,) conducted a cohort in Acute kidney injury after percutaneous coronary intervention (n=453,475). In-hospital Acute Kidney Injury (AKI) vs. No AKI was evaluated on Death, myocardial infarction, or bleeding (HR 1.53, 95% CI 1.49-1.56). In-hospital AKI after PCI was associated with a higher 1-year post-discharge hazard of death, MI, or bleeding compared with no AKI (AKIN 1: HR 1.53; 95% CI 1.49-1.56).