Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland.
Department of Biomedical Sciences, Humanitas University, Emanuele, Italy.
JACC Cardiovasc Interv. 2023 Aug 14;16(15):1873-1886. doi: 10.1016/j.jcin.2023.06.015.
A simple, contemporary risk score for the prediction of contrast-associated acute kidney injury (CA-AKI) after percutaneous coronary intervention (PCI) was recently updated, although its external validation is lacking.
The aim of this study was to validate the updated CA-AKI risk score in a large cohort of acute coronary syndrome patients from the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of angioX) trial.
The risk score identifies 4 risk categories for CA-AKI. The primary endpoint was to appraise the receiver-operating characteristics of an 8-component and a 12-component CA-AKI model. Independent predictors of Kidney Disease Improving Global Outcomes-based acute kidney injury and the impact of CA-AKI on 1-year mortality and bleeding were also investigated.
The MATRIX trial included 8,201 patients with complete creatinine values and no end-stage renal disease. CA-AKI occurred in 5.5% of the patients, with a stepwise increase of CA-AKI rates from the lowest to the highest of the 4 risk categories. The receiver-operating characteristic area under the curve was 0.67 (95% CI: 0.64-0.70) with model 1 and 0.71 (95% CI: 0.68-0.74) with model 2. CA-AKI risk was systematically overestimated with both models (Hosmer-Lemeshow goodness-of-fit test: P < 0.05). The 1-year risks of all-cause mortality and bleeding were higher in CA-AKI patients (HR: 7.03 [95% CI: 5.47-9.05] and HR: 3.20 [95% CI: 2.56-3.99]; respectively). There was a gradual risk increase for mortality and bleeding as a function of the CA-AKI risk category for both models.
The updated CA-AKI risk score identifies patients at incremental risks of acute kidney injury, bleeding, and mortality. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of angioX [MATRIX]; NCT01433627).
最近更新了一种用于预测经皮冠状动脉介入治疗（PCI）后对比剂相关急性肾损伤（CA-AKI）的简单、现代风险评分，但缺乏外部验证。
本研究旨在对 MATRIX（经桡动脉入路和血管内治疗的 angioX 系统实施以减少出血不良事件）试验中一组大型急性冠状动脉综合征患者的更新后的 CA-AKI 风险评分进行验证。
该风险评分确定了 CA-AKI 的 4 个风险类别。主要终点是评估 8 成分和 12 成分 CA-AKI 模型的接收者操作特性。还研究了基于肾脏病改善全球结局的急性肾损伤的独立预测因素以及 CA-AKI 对 1 年死亡率和出血的影响。
MATRIX 试验纳入了 8201 例有完整肌酐值且无终末期肾病的患者。患者中有 5.5%发生 CA-AKI，随着风险类别从低到高，CA-AKI 发生率呈逐步上升趋势。模型 1 的受试者工作特征曲线下面积为 0.67（95%CI：0.64-0.70），模型 2 的曲线下面积为 0.71（95%CI：0.68-0.74）。两种模型均系统性地高估了 CA-AKI 风险（Hosmer-Lemeshow 拟合优度检验：P<0.05）。CA-AKI 患者的 1 年全因死亡率和出血风险更高（HR：7.03 [95%CI：5.47-9.05]和 HR：3.20 [95%CI：2.56-3.99]）。对于两种模型，死亡率和出血风险都随着 CA-AKI 风险类别的增加而逐渐增加。
更新后的 CA-AKI 风险评分可识别出急性肾损伤、出血和死亡率风险逐渐增加的患者。（经桡动脉入路和血管内治疗的 angioX 系统实施以减少出血不良事件[MATRIX]；NCT01433627）。
