In acute coronary syndrome patients undergoing percutaneous coronary intervention, contrast-induced acute kidney injury significantly increased the risk of all-cause mortality (RR 3.16).
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?
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.
Effect estimate: RR 3.16 (95% CI 2.52-3.97)
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.
Yang et al. (Sat,) 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 significantly increased the risk of all-cause mortality (RR 3.16).