Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Cardiol. 2021 Oct 1;156:39-43. doi: 10.1016/j.amjcard.2021.06.033. Epub 2021 Jul 27.
Acute kidney injury (AKI) is a complication of percutaneous coronary intervention (PCI), known to increase rates of adverse medical events. We aimed to identify the optimal definition of AKI in predicting adverse cardiovascular outcomes and mortality post PCI. From a large registry of patients undergoing PCI between 2006-2018 (n = 25,690) at our medical center, consecutive patients were assessed for the presence of AKI according to four different definitions: a relative elevation of ≥25% or ≥50%; or an absolute elevation of ≥0.3 mg/dL or ≥0.5 mg/dL in serum creatinine at 48 hours post PCI. We assessed the calculated rates of AKI according to the different definitions. The discriminant capacity for 30-day and 1-year mortality and MACE (MACE: all-cause death, myocardial infarction, target-vessel revascularization and coronary artery bypass graft surgery) of each definition was calculated using ROC curves and AUCs. Data of 15,153 patients was available for the final analysis. Rates of AKI were 12.1%, 3.2%, 8.1% and 3.9% according to the four definitions, respectively. The discriminant capacity of adverse outcomes was highest among those defined as AKI according to the third definition - an absolute elevation of ≥0.3 mg/dL in serum creatinine with an AUC of 0.82 (95% CI 0.80-0.84) for 30-day mortality (P value = 0.036) and an AUC of 0.78 (CI 0.76-0.79) for 30-day MACE. In conclusion, an absolute elevation of ≥ 0.3 mg/dL in serum creatinine 48 hours post PCI predicts overall mortality and MACE most accurately.
急性肾损伤（AKI）是经皮冠状动脉介入治疗（PCI）的一种并发症，已知会增加不良医疗事件的发生率。我们旨在确定 AKI 的最佳定义，以预测 PCI 后不良心血管结局和死亡率。从我们医疗中心 2006-2018 年期间进行的一项大型 PCI 患者登记研究（n=25690）中，连续患者根据以下四种不同定义评估 AKI 的存在：相对升高≥25%或≥50%；或血清肌酐在 PCI 后 48 小时绝对升高≥0.3mg/dL 或≥0.5mg/dL。我们评估了根据不同定义计算的 AKI 发生率。使用 ROC 曲线和 AUC 计算每种定义对 30 天和 1 年死亡率和 MACE（MACE：全因死亡、心肌梗死、靶血管血运重建和冠状动脉旁路移植术）的判别能力。15153 例患者的数据可用于最终分析。根据四种定义，AKI 的发生率分别为 12.1%、3.2%、8.1%和 3.9%。根据第三个定义，将血清肌酐绝对升高≥0.3mg/dL 定义为 AKI 的判别能力最高，30 天死亡率的 AUC 为 0.82（95%CI 0.80-0.84）（P 值=0.036），30 天 MACE 的 AUC 为 0.78（CI 0.76-0.79）。总之，PCI 后 48 小时血清肌酐绝对升高≥0.3mg/dL 最能准确预测总死亡率和 MACE。
