Abstract 17970: Incidence and Impact of Contrast-Associated Acute Kidney Injury in High-Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention

Abstract

Introduction: Contrast-associated acute kidney injury (CA-AKI) is associated with increased morbidity and mortality following percutaneous coronary intervention (PCI). The incidence and impact of CA-AKI in high-bleeding risk (HBR) patients undergoing PCI remain unknown. Methods: We included patients who underwent PCI at a tertiary care center (Mount Sinai Hospital, NY) between 2012 and 2019. Patients were classified as HBR if they met ≥1 major or ≥2 minor criteria according to the Academic Research Consortium (ARC)-HBR definition. CA-AKI was defined according to the Acute Kidney Injury Network as an increase in serum creatinine by ≥50% or ≥0.3 mg/dL within 48 hours after PCI. The primary outcome was all-cause death within 1 year after PCI. Secondary outcomes included myocardial infarction, stent thrombosis, all-cause stroke, post-discharge and all bleeding. Results: Out of 16,966 patients, 7,295 (43.0%) were classified as HBR. CA-AKI occurred in 10.8% of HBR and 3.0% of non-HBR patients (p<0.001). Among HBR patients, those who had CA-AKI were younger and had a higher prevalence of anemia (81.4% vs. 67.7%, p<0.001), diabetes (66.8% vs. 52.8%, p<0.001), and kidney disease (83.8% vs. 50.8%, p<0.001) than those who did not. In contrast, fewer differences in baseline characteristics were observed in non-HBR patients with vs. without CA-AKI. The occurrence of CA-AKI was associated with an increased risk of all-cause death (HBR: HR 3.13, 95% CI [2.39-4.09]; non-HBR: HR 9.11, 95% CI [4.91-16.9]) and other adverse events in both HBR and non-HBR patients (Figure 1). Interestingly, a significant interaction was noted between HBR status and CA-AKI with respect to all-cause death (p-interaction=0.002). Conclusions: CA-AKI occurred at a significantly higher rates in HBR vs. non-HBR patients undergoing PCI and was associated with a significant increase in adverse events. Nonetheless, the impact of CA-AKI on all-cause death was lower in HBR vs. non-HBR patients.