Refining Safe Contrast Limits for Preventing Acute Kidney Injury After Percutaneous Coronary Intervention.

Content Provider	Europe PMC
Author	Yuan, Neal Latif, Khalid Botting, Patrick G. Elad, Yaron Bradley, Steven M. Nuckols, Teryl K. Cheng, Susan Ebinger, Joseph E.
Abstract	BackgroundContrast‐associated acute kidney injury (CA‐AKI) is associated with substantial morbidity and may be prevented by using less contrast during percutaneous coronary intervention (PCI). However, tools for determining safe contrast volumes are limited. We developed risk models to tailor safe contrast volume limits during PCI.Methods and ResultsUsing data from all PCIs performed at 18 hospitals from January 2015 to March 2018, we developed logistic regression models for predicting CA‐AKI, including simpler models (“pragmatic full,” “pragmatic minimum”) using only predictors easily derivable from electronic health records. We prospectively validated these models using PCI data from April 2018 to December 2018 and compared them to preexisting safe contrast models using the area under the receiver operating characteristic curve (AUC). The model derivation data set included 20 579 PCIs with 2102 CA‐AKI cases. When applying models to the separate validation data set (5423 PCIs, 488 CA‐AKI cases), prior safe contrast limits (5*Weight/Creatinine, 2*CreatinineClearance) were poor measures of safety with accuracies of 53.7% and 56.6% in predicting CA‐AKI, respectively. The full, pragmatic full, and pragmatic minimum models performed significantly better (accuracy, 73.1%, 69.3%, 66.6%; AUC, 0.80, 0.76, 0.72 versus 0.59 for 5 * Weight/Creatinine, 0.61 for 2*CreatinineClearance). We found that applying safe contrast limits could meaningfully reduce CA‐AKI risk in one‐quarter of patients.ConclusionsCompared with preexisting equations, new multivariate models for safe contrast limits were substantially more accurate in predicting CA‐AKI and could help determine which patients benefit most from limiting contrast during PCI. Using readily available electronic health record data, these models could be implemented into electronic health records to provide actionable information for improving PCI safety.
Page Count	14
Journal	Journal of the American Heart Association
Volume Number	10
PubMed Central reference number	PMC7955500
Issue Number	1
PubMed reference number	33325246
e-ISSN	20479980
DOI	10.1161/jaha.120.018890
Language	English
Publisher	John Wiley and Sons Inc.
Publisher Date	2020-12-16
Publisher Place	Hoboken
Access Restriction	Open
Rights License	This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Subject Keyword	contrast‐associated acute kidney injury contrast‐induced nephropathy percutaneous coronary intervention Quality and Outcomes Percutaneous Coronary Intervention
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine