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NEW DEFINITION OF CI-AKI:COMBINED SERUM CREATININE AND CYSTATIN C
1368 JACC March 21, 2017 Volume 69, Issue 11
Interventional Cardiology NEW DEFINITION OF CI-AKI:COMBINED SERUM CREATININE AND CYSTATIN C Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Interventional Complexity and Complications Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications Presentation Number: 1285-172 Authors: Tuo Zhang, Weifeng Zhang, Linghong Shen, Ben He, Department of Cardiology, Renji Hospital, Shanghai, People’s Republic of China
Background: Contrast-induced acute kidney injury (CI-AKI) was traditionally defined as an increase of serum creatinine (sCr) after contrast media (CM) exposure. Recently, serum cystatin C (sCyC) has been proposed as an alternative to sCr to detect acute changes in renal function. The clinical implication of combining sCyC and sCr as new definition of CI-AKI is still unknown.
Methods: 1071 consecutive patients undergoing coronary angiography/intervention were prospectively enrolled. SCyC and sCr were assessed at baseline and 24-48 hours after CM exposure. SCr-based definition of CI-AKI (CI-AKIsCr) was defined as a sCr increase ≥0.3mg/ dl or 50% from baseline. Major adverse events (MAEs) at 12 months were assessed.
Results: CI-AKIsCr developed in 25 patients (2.3%). 12 month follow-up was available in 1063 patients and MAEs occurred in 61 patients (5.7%). By receiver operating characteristic curve analysis, a sCyC increase ≥15% was the optimal increment cutoff value for CI-AKIsCr detection, which occurred in 187 patients (17.4%). Combining sCyC and sCr as new definition of CI-AKI, patients were stratified into 3 groups: no CI-AKI, CI-AKI detected by single marker, and CI-AKI detected by both markers. Multivariable logistic regression revealed that predictability of MAEs trends toward a stepwise increase along with 3 groups (no CI-AKI group as the reference, CI-AKI detected by single marker: odds ratio (OR) =2.34, 95% confidence interval (CI): 1.27-4.32, P=0.10; CI-AKI detected by both markers: OR=13.24, 95%CI: 3.4550.81, P<0.001). Conclusions: Combining sCyC and sCr as new definition of CI-AKI would be beneficial for risk stratification and outcome prediction in patients after CM exposure.
Interventional Cardiology NEW DEFINITION OF CI-AKI:COMBINED SERUM CREATININE AND CYSTATIN C Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Interventional Complexity and Complications Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications Presentation Number: 1285-172 Authors: Tuo Zhang, Weifeng Zhang, Linghong Shen, Ben He, Department of Cardiology, Renji Hospital, Shanghai, People’s Republic of China
Background: Contrast-induced acute kidney injury (CI-AKI) was traditionally defined as an increase of serum creatinine (sCr) after contrast media (CM) exposure. Recently, serum cystatin C (sCyC) has been proposed as an alternative to sCr to detect acute changes in renal function. The clinical implication of combining sCyC and sCr as new definition of CI-AKI is still unknown.
Methods: 1071 consecutive patients undergoing coronary angiography/intervention were prospectively enrolled. SCyC and sCr were assessed at baseline and 24-48 hours after CM exposure. SCr-based definition of CI-AKI (CI-AKIsCr) was defined as a sCr increase ≥0.3mg/ dl or 50% from baseline. Major adverse events (MAEs) at 12 months were assessed.
Results: CI-AKIsCr developed in 25 patients (2.3%). 12 month follow-up was available in 1063 patients and MAEs occurred in 61 patients (5.7%). By receiver operating characteristic curve analysis, a sCyC increase ≥15% was the optimal increment cutoff value for CI-AKIsCr detection, which occurred in 187 patients (17.4%). Combining sCyC and sCr as new definition of CI-AKI, patients were stratified into 3 groups: no CI-AKI, CI-AKI detected by single marker, and CI-AKI detected by both markers. Multivariable logistic regression revealed that predictability of MAEs trends toward a stepwise increase along with 3 groups (no CI-AKI group as the reference, CI-AKI detected by single marker: odds ratio (OR) =2.34, 95% confidence interval (CI): 1.27-4.32, P=0.10; CI-AKI detected by both markers: OR=13.24, 95%CI: 3.4550.81, P<0.001). Conclusions: Combining sCyC and sCr as new definition of CI-AKI would be beneficial for risk stratification and outcome prediction in patients after CM exposure.