The incidence and prognostic value of acute kidney injury in diabetic patients following percutaneous coronary intervention

Background

Acute kidney injury (AKI) following percutaneous coronary intervention (PCI) is associated with high rates of short- and long-term complications. Diabetes in particular is an important risk factor for AKI. We aimed to describe the prognostic impact of AKI in diabetic patients following PCI.

Methods

From a prospective registry of patients undergoing PCI at Rabin medical center, 12,260 consecutive diabetic patients were assessed, between the years 2006 and 2018. Of these, we included only 8,268 cases who were treated with drug-eluting stents, and for whom data existed regarding change in creatinine levels from baseline to 48 hours after PCI. 3,598 (43.5%) had no change in renal function, and the other 4,670 patients were divided to quartiles of change – 1 to 4. Endpoints included death and MACE (cardiac death, myocardial infarction, target vessel revascularization and coronary artery bypass surgery) at 30 days and 3 years.

Results

Patients were older in the 4^th quartile (65.8, 66.6, 67.3, 67.2, 68.4 years), as was female gender (24, 23, 24, 28, 38 percent).

Rates of death at 30 days were correlated with higher quartiles: 0.7,1.8, 1.7, 2.9 and 11% for no change and the quartiles 1-4, respectively. Rates of MACE at 30 days were 1.7, 2.8, 2.3, 4.2 and 12.9%, respectively. Results at 3 years had the respective mortality rates of 21.7, 26.9, 24.4, 25.7 and 37.6% (figure 1), and MACE rates of 33.4, 38.7, 35.4, 38.6 and 47.8% (figure 2). Regression showed AKI is an independent factor for adverse outcomes (HR-1.116, CI 1.062-1.17, p

Conclusions

In our registry of diabetic patients following PCI, rates of short- and long-term mortality and MACE were significantly higher among those with greater change in creatinine level 2 days following intervention.