Atrial Plication with Appendage Obliteration during MVR, in Huge Left atrium, Early Outcome

Abstract

Objective: There is ongoing reassessment of the definition of incidental acute kidney injury (AKI) after hospital-administered intravenous contrast, namely as “contrast-induced nephropathy” (CIN). Contrast-induced acute kidney injury (CI-AKI) is of potential importance in predicting cardiovascular outcome. Recently, a novel CI-AKI definition was proposed by the foundation KDIGO (Kidney Disease: Improving Global Outcomes). We compared the prognostic value of two definitions among patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Methods: We retrospectively analyzed data for 334 patients and used Cox proportional hazard analysis to assess whether KDIGO (Kidney Disease: Improving Global Outcomes) - or CIN-defined CI-AKI better predicted midterm major adverse cardio-cerebrovascular events (MACCE). MACCE included heart failure requiring hospitalization, cardiac death, non-fatal ACS, target vessel revascularization, or stroke. Results: MACCE incidence was significantly higher for patients with KDIGO-defined CI-AKI (18.2% vs. 50%, p < 0.001) but not for patients with CIN-defined CI-AKI (19.4% vs. 28.0%, p = 0.18). Independent predictors of MACCE included the KDIGO-defined CI-AKI (hazard ratio [HR]: 2.49, 95% confidence interval [CI]: 1.33–4.66, p < 0.01), age (HR: 1.03, 95% CI: 1.01–1.05, p < 0.01), contrast medium volume (HR: 2.52, 95% CI: 1.13–5.63, p = 0.02), intra-aortic balloon pump use (HR: 2.23, 95% CI: 1.22–4.06, p < 0.01), and left anterior descending culprit (HR: 1.79, 95% CI: 1.07–2.99, p < 0.01), but not the CIN-defined CI-AKI (HR: 0.61, 95%CI: 0.29–1.25, p = 0.18). Conclusion: The KDIGO-based, but not the CIN-based, definition of CI-AKI accurately predicted increased risk of MACCE for ACS patients undergoing PCI.