Kooiman Judith, Seth Milan, Nallamothu Brahmajee K, Heung Michael, Humes David, Gurm Hitinder S
From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.).
Circ Cardiovasc Interv. 2015 Jun;8(6):e002212. doi: 10.1161/CIRCINTERVENTIONS.114.002212.
Acute kidney injury (AKI) post percutaneous coronary intervention (PCI) is associated with increased mortality but both death and AKI share common risk factors. Moreover, the effect of a high contrast dose, a known modifiable risk factor for AKI, on mortality is unknown. The aim of our study was to analyze the association between AKI and in-hospital mortality post PCI after adjustment for confounding by common risk factors.
This study was performed using a regional registry of all patients undergoing PCI in Michigan. Primary end points were AKI (serum creatinine increase >0.5 mg/dL) and all-cause in-hospital mortality. Propensity matching was performed, with each AKI patient matched to 4 controls. Attributable risk fraction and the exposed index number of AKI for mortality were calculated within the propensity-matched cohort. Between 2010 and 2013, 92 317 patients underwent PCI, of whom 2141 (2.3%) developed AKI. We matched 1371/2141 patients with AKI to 5484 controls. AKI was strongly associated with mortality (odds ratio=12.52, 95% confidence interval 9.29-16.86) in the propensity-matched cohort. The attributable risk fraction for mortality of AKI was 31.4% (95% confidence interval 26.8%-37.5%), and one death could be prevented for every 9 cases of AKI successfully avoided. The independent impact of a high contrast dose at time of PCI on in-hospital mortality risk was weak (adjusted odds ratio 1.19, 95% confidence interval 0.97-1.45).
Nearly one-third of the in-hospital mortality post PCI is attributable to AKI. Preventing 9 cases of AKI could potentially prevent one death. These study findings stress the need for developing effective AKI preventive strategies beyond minimization of contrast dose.
经皮冠状动脉介入治疗（PCI）后发生的急性肾损伤（AKI）与死亡率增加相关，但死亡和AKI具有共同的危险因素。此外，高造影剂剂量作为已知的可改变的AKI危险因素，其对死亡率的影响尚不清楚。我们研究的目的是在对常见危险因素造成的混杂因素进行校正后，分析PCI术后AKI与院内死亡率之间的关联。
本研究使用密歇根州所有接受PCI患者的区域登记资料进行。主要终点为AKI（血清肌酐升高>0.5mg/dL）和全因院内死亡率。进行倾向匹配，将每名AKI患者与4名对照进行匹配。在倾向匹配队列中计算死亡率的归因风险分数和AKI的暴露指数。2010年至2013年期间，92317例患者接受了PCI，其中2141例（2.3%）发生了AKI。我们将1371/2141例AKI患者与5484名对照进行了匹配。在倾向匹配队列中，AKI与死亡率密切相关（比值比=12.52，95%置信区间9.29-16.86）。AKI导致死亡的归因风险分数为31.4%（95%置信区间26.8%-37.5%），每成功避免9例AKI可预防1例死亡。PCI时高造影剂剂量对院内死亡风险的独立影响较弱（校正比值比1.19，95%置信区间0.97-1.45）。
PCI术后近三分之一的院内死亡可归因于AKI。预防9例AKI可能预防1例死亡。这些研究结果强调，除了尽量减少造影剂剂量外，还需要制定有效的AKI预防策略。
