Key result
In acute coronary syndrome patients undergoing percutaneous coronary intervention, contrast-induced acute kidney injury increased the risk of all-cause mortality.
Why the study?
Studies evaluating the association between CI-AKI and adverse clinical outcomes in ACS patients undergoing PCI have yielded inconsistent and widely varying risk estimates.
Does contrast-induced acute kidney injury increase the risk of adverse clinical outcomes in acute coronary syndrome patients undergoing percutaneous coronary intervention?
Meta-Analysis (n=32,781)
Does contrast-induced acute kidney injury increase the risk of adverse clinical outcomes in acute coronary syndrome patients undergoing percutaneous coronary intervention?
Answers are grounded in this paper and cite their sources.
In ACS patients undergoing PCI, the development of contrast-induced acute kidney injury is strongly associated with significantly increased risks of short- and long-term mortality, MACE, MACCE, and stent restenosis.
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. 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. 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. 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.
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Yang et al. (2018) conducted a meta-analysis in Acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) (n=32,781). Contrast-induced acute kidney injury (CI-AKI) vs. No CI-AKI was evaluated on All-cause mortality (RR 3.16, 95% CI 2.52-3.97). In acute coronary syndrome patients undergoing percutaneous coronary intervention, contrast-induced acute kidney injury increased the risk of all-cause mortality.
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