Division of Cardiology, Baptist Health-Heart and Vascular Center, Louisville, Kentucky.
Division of Cardiology, Columbia University Medical Center, New York, New York.
Catheter Cardiovasc Interv. 2020 May 1;95(6):1111-1121. doi: 10.1002/ccd.28400. Epub 2019 Jul 29.
Protection against acute kidney injury (AKI) has been reported with the use of Impella during high-risk percutaneous coronary intervention (HR-PCI). We sought to evaluate this finding by determining the occurrence of AKI during Impella-supported HR-PCI in patients from the Global cVAD Study and compare this incidence with their calculated AKI risk at baseline.
In this prospective, multicenter study, we enrolled 314 consecutive patients. We included 223 patients that underwent nonemergent HR-PCI supported with Impella 2.5 or Impella CP and excluded those requiring hemodialysis prior to HR-PCI (19) and those with insufficient data (72). The primary outcome was AKI postprocedurally at 48 hr versus the predicted risk of AKI according to Mehran risk score. Logistic regression analysis determined predictors of AKI. Overall, 4.9% (11) of Impella-supported patients developed AKI (exclusively stage 1) at 48 hr versus a predicted rate of 21.9%, representing a 77.6% lower AKI rate (p < .0001). In this study, no Impella-supported patients required renal replacement therapy. Estimated glomerular filtration rate (ml/min/1.73 m ) alone predicted AKI (adjusted odds ratio [AOR]: 4.915; 95% confidence intervals [CI]: 1.02-23.53, p = .046), and increasing contrast had insignificant effects on AKI during high-risk PCI (AOR: 1.15; 95% CI: 0.87-1.51, p = .332). In patients not protected from AKI, the postprocedure incidence of AKI was not significantly greater and did not correlate with chronic kidney disease severity.
The incidence of AKI was lower during HR-PCI than expected from current risk models. Although further exploration of this finding is warranted, these data support a new protective strategy against AKI during HR-PCI.
在高危经皮冠状动脉介入治疗（HR-PCI）中使用 Impella 已被报道可预防急性肾损伤（AKI）。我们通过确定在全球 cVAD 研究中的接受 Impella 支持的 HR-PCI 患者的 AKI 发生率，并将其与基线时的 AKI 风险进行比较，来评估这一发现。
在这项前瞻性、多中心研究中，我们纳入了 314 例连续患者。我们纳入了 223 例接受非紧急 HR-PCI 并使用 Impella 2.5 或 Impella CP 支持的患者，并排除了在 HR-PCI 前需要血液透析的患者（19 例）和数据不足的患者（72 例）。主要结局是在 48 小时时的术后 AKI 与根据 Mehran 风险评分预测的 AKI 风险之间的差异。逻辑回归分析确定了 AKI 的预测因素。总的来说，4.9%（11 例）接受 Impella 支持的患者在 48 小时时发生 AKI（仅为 1 期），而预测的 AKI 发生率为 21.9%，这表明 AKI 发生率降低了 77.6%（p<0.0001）。在这项研究中，没有接受 Impella 支持的患者需要肾脏替代治疗。估计肾小球滤过率（ml/min/1.73m）单独预测 AKI（调整后的优势比 [AOR]：4.915；95%置信区间 [CI]：1.02-23.53，p=0.046），而高危 PCI 中增加造影剂的用量对 AKI 没有显著影响（AOR：1.15；95%CI：0.87-1.51，p=0.332）。在未预防 AKI 的患者中，术后 AKI 的发生率没有显著增加，且与慢性肾脏病严重程度无关。
在 HR-PCI 期间，AKI 的发生率低于当前风险模型所预测的水平。尽管需要进一步探索这一发现，但这些数据支持在 HR-PCI 期间采用新的 AKI 预防策略。
