Validation of a Contemporary Acute Kidney Injury Risk Score in Patients With Acute Coronary Syndrome

Antonio Landi; Mauro Chiarito; Mattia Branca; Enrico Frigoli; Andrea Gagnor; Paolo Calabrò; Carlo Briguori; Giuseppe Andò; Alessandra Repetto; Ugo Limbruno; Paolo Sganzerla; Alessandro Lupi; Bernardo Cortese; Arturo Ausiello; Salvatore Ierna; Giovanni Esposito; Giuseppe Ferrante; Andrea Santarelli; Gennaro Sardella; Ferdinando Varbella; Dik Heg; Roxana Mehran; Marco Valgimigli

doi:10.1016/j.jcin.2023.06.015

Validation of a Contemporary Acute Kidney Injury Risk Score in Patients With Acute Coronary Syndrome

JACC Cardiovasc Interv. 2023 Aug 14;16(15):1873-1886. doi: 10.1016/j.jcin.2023.06.015.

Authors

Antonio Landi¹, Mauro Chiarito², Mattia Branca³, Enrico Frigoli⁴, Andrea Gagnor⁵, Paolo Calabrò⁶, Carlo Briguori⁷, Giuseppe Andò⁸, Alessandra Repetto⁹, Ugo Limbruno¹⁰, Paolo Sganzerla¹¹, Alessandro Lupi¹², Bernardo Cortese¹³, Arturo Ausiello¹⁴, Salvatore Ierna¹⁵, Giovanni Esposito¹⁶, Giuseppe Ferrante¹⁷, Andrea Santarelli¹⁸, Gennaro Sardella¹⁹, Ferdinando Varbella²⁰, Dik Heg³, Roxana Mehran²¹, Marco Valgimigli²²

Affiliations

¹ Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland.
² Department of Biomedical Sciences, Humanitas University, Emanuele, Italy.
³ CTU Bern, University of Bern, Bern, Switzerland.
⁴ Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
⁵ Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy.
⁶ Division of Cardiology, "Sant'Anna e San Sebastiano" Hospital, Caserta, Italy; Department of Translational Medicine, University of Campania "Luigi Vanvitelli," Caserta, Italy.
⁷ Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy.
⁸ Cardiology Unit, Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino," University of Messina, Messina, Italy.
⁹ Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
¹⁰ Cardiology Department, Misericordia Hospital, Grosseto, Italy.
¹¹ IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy.
¹² Division of Cardiology, Hospital of Domodossola, Domodossola, Verbano-Cusio-Ossola, Italy.
¹³ Cardiovascular Research Center, Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy.
¹⁴ Casa di Cura Villa Verde, Taranto, Italy.
¹⁵ Interventional Cardiology Unit, Ospedale di Carbonia, Carbonia, Italy.
¹⁶ Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
¹⁷ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Cardiovascular Medicine, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy.
¹⁸ Cardiology Unit, Infermi Hospital, Rimini, Italy.
¹⁹ Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
²⁰ Cardiology Unit, Azienda Ospedaliera Universitaria San Luigi Gonzaga Orbassano, Turin, Italy.
²¹ The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
²² Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland. Electronic address: marco.valgimigli@eoc.ch.

PMID: 37587595
DOI: 10.1016/j.jcin.2023.06.015

Abstract

Background: A simple, contemporary risk score for the prediction of contrast-associated acute kidney injury (CA-AKI) after percutaneous coronary intervention (PCI) was recently updated, although its external validation is lacking.

Objectives: The aim of this study was to validate the updated CA-AKI risk score in a large cohort of acute coronary syndrome patients from the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of angioX) trial.

Methods: The risk score identifies 4 risk categories for CA-AKI. The primary endpoint was to appraise the receiver-operating characteristics of an 8-component and a 12-component CA-AKI model. Independent predictors of Kidney Disease Improving Global Outcomes-based acute kidney injury and the impact of CA-AKI on 1-year mortality and bleeding were also investigated.

Results: The MATRIX trial included 8,201 patients with complete creatinine values and no end-stage renal disease. CA-AKI occurred in 5.5% of the patients, with a stepwise increase of CA-AKI rates from the lowest to the highest of the 4 risk categories. The receiver-operating characteristic area under the curve was 0.67 (95% CI: 0.64-0.70) with model 1 and 0.71 (95% CI: 0.68-0.74) with model 2. CA-AKI risk was systematically overestimated with both models (Hosmer-Lemeshow goodness-of-fit test: P < 0.05). The 1-year risks of all-cause mortality and bleeding were higher in CA-AKI patients (HR: 7.03 [95% CI: 5.47-9.05] and HR: 3.20 [95% CI: 2.56-3.99]; respectively). There was a gradual risk increase for mortality and bleeding as a function of the CA-AKI risk category for both models.

Conclusions: The updated CA-AKI risk score identifies patients at incremental risks of acute kidney injury, bleeding, and mortality. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of angioX [MATRIX]; NCT01433627).

Keywords: acute coronary syndrome; acute kidney injury; percutaneous coronary intervention; risk score.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Acute Coronary Syndrome* / diagnostic imaging
Acute Coronary Syndrome* / therapy
Acute Kidney Injury* / chemically induced
Acute Kidney Injury* / diagnosis
Humans
Percutaneous Coronary Intervention* / adverse effects
Risk Factors
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01433627