Impact of Renal Function and Acute Kidney Injury on Long-term Outcomes After Percutaneous Coronary Intervention

Objective

To determine the incidence, predictors, and prognostic implications of acute kidney injury (AKI) after percutaneous coronary intervention (PCI).

Patients and Methods

Retrospective analysis of the Mayo Clinic PCI registry identified 9199 patients who underwent PCI from January 1, 2009, through June 30, 2023.

Results

A total of 856 patients (9.3%) developed AKI (increase in serum creatinine level by ≥0.3 mg/dL or ≥1.5 times baseline), with 87 (0.9%) requiring hemodialysis. A monotonic increase in the yearly incidence of AKI was observed (P<.001). In multivariable analysis, AKI was associated with older age (odds ratio [OR], 1.01; 95% CI, 1.00 to 1.02), female sex (OR, 1.27; 95% CI, 1.08 to 1.49), diabetes (OR, 1.62; 95% CI, 1.38 to 1.89), congestive heart failure (OR, 2.99; 95% CI, 2.54 to 3.52), chronic kidney disease (OR, 2.46; 95% CI, 2.00 to 3.02), acute myocardial infarction (OR, 3.34; 95% CI, 2.80 to 3.99), intra-aortic balloon pump (OR, 3.49; 95% CI, 2.55 to 4.73), and contrast volume (OR, 1.28; 95% CI, 1.17 to 1.41). In-hospital mortality was 11.1% vs 1.0% in patients with vs without AKI (P<.001). After adjustment, AKI remained strongly associated with in-hospital mortality (hazard ratio, 5.75; 95% CI, 4.06 to 8.13). Among hospital survivors, 1-, 5-, and 10-year all-cause mortality, repeated revascularization, myocardial infarction, and major adverse cardiovascular event rates were significantly higher in those who developed AKI.

Conclusions

The incidence of AKI after PCI remains high in the contemporary era. Higher in-hospital and long-term mortality and adverse cardiac event rates were noted in patients who developed AKI after PCI.