Impact of Periprocedural Bleeding on Incidence of Contrast-Induced Acute Kidney Injury in Patients Treated With Percutaneous Coronary Intervention

Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Journal of the American College of Cardiology (Impact Factor: 16.5). 06/2013; 62(14). DOI: 10.1016/j.jacc.2013.03.086
Source: PubMed


OBJECTIVES: We sought to evaluate the association between contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) and severity of bleeding estimated from periprocedural hemoglobin (Hb) measurement. BACKGROUND: The relationship between CI-AKI and bleeding in contemporary practice remains controversial. METHODS: In a retrospective analysis of the prospectively maintained JCD-KICS multicenter registry, we divided 2646 consecutive patients into 5 groups according to the change of Hb level post relative to pre PCI: patients without Hb level decrease (Group A); and patients with decreased Hb level: <1g/dL (Group B); 1-<2g/dL (Group C); 2-<3g/dL (Group D); and >3g/dL (Group E). CI-AKI was defined as an increase in serum creatinine (Cr) level ≥0.5 mg/dL or ≥25% above baseline values at 48 hours after administration of contrast media. Procedural and outcome variables were compared. RESULTS: Mean age was 67±11 years. Of 2646 patients, 315 (11.9%) developed CI-AKI. CI-AKI incidence was 6.2%, 7.5%, 10.7%, 17.0%, and 26.2%, in groups A through E, respectively (P < 0.01), whereas incidence of major bleeding was 0.7%, 1.3%, 2.0%, 4.1%, and 28.3%, respectively (P < 0.01). CI-AKI was associated with higher rates of mortality (5.4% vs. 0.6%, P < 0.01), and also of the composite of heart failure, cardiogenic shock, and death (16.5% vs. 2.8%, P < 0.01). CONCLUSIONS: Periprocedural bleeding was significantly associated with CI-AKI, with CI-AKI incidence correlating with bleeding severity.

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