Acute kidney injury and multivessel percutaneous coronary interventions in chronic renal disease: the AMICI study.

BACKGROUND Patients with chronic kidney disease (CKD) often have multivessel coronary artery disease and the risk of acute kidney injury (AKI) after percutaneous coronary interventions (PCI) is high. The aim of this study was to evaluate the risk of AKI in patients with CKD who underwent single vessel PCI versus multivessel PCI. METHODS We retrospectively screened all PCI performed from January 2011 to December 2017 and we included all the procedures performed in patients with a baseline glomerular filtration rate <60 ml/min/1.73 m2. PCI were divided in two groups according to the treatment of a single vessel (Mono Group) or multivessel PCI (Multi Group). The Multi Group was also divided in two subgroups according to the modality of PCI: multivessel PCI performed in one procedure (Multi-Single session Group) or in multiple staged procedures (Multi-Staged Group). RESULTS From a total of 4517 PCI screened, 848 PCI were included, 530 in the Mono Group and 318 in the Multi Group. The global rate of AKI was around 15% without significant differences between the Mono and the Multi Group (15.5% in the Mono and 14.8% in the Multi Group, p=0.786). In the Multi Group the risk of AKI was significantly higher in the Single session sub-group (21.4%) compared to the staged sub-group (11.2%, p= 0.014). CONCLUSIONS In patients with CKD, the risk of AKI did not differ in patients who underwent single vessel versus multivessel PCI, but multivessel PCI should be performed in multiple staged procedures rather than in a single session.