Analysis Of Clinical Basic Characteristics And The Trend In Patients Who Underwent Emergency Percutaneous Coronary Interventions With Or Without Contrast-induced Acute Kidney Injury And Establishment Of A Novel Risk Score Model Of Contrast-induced Acute K

Objectives:Presently,studies about contrast-induced acute kidney injury(CI-AKI)in patients with coronary artery disease(CAD)after undergoing coronary artery arteriography(CAG)or percutaneous coronary intervention(PCI)were almost based on population with elective PCIs.The proportion was usually small even if emergency PCI patients were included.Till now,there are no large-sampled clinical study exploring the risk factors and prognosis of CI-AKI in patients who underwent emergency PCIs.Our study will retrospectively explore the clinical characteristics and the trend during 6 years(2013-2018)in a Chinese population with CAD undergoing emergency PCIs,establish and initially verify a CI-AKI risk score model for emergency PCI patients,and analyze the incidence and the incidence trend of clinical endpoint events at 1 and 12 months follow-up after discharge.Methods:Patients with CAD who underwent emergency PCIs in our hospital from January 1,2013 to December 31,2018 were included in the study.The patients were divided into CI-AKI and non-CI-AKI groups.Analysis of clinical baseline characteristics,intervention characteristics,medication and the trend of the basic factors during 6 years was performed in the whole emergency PCI population,CI-AKI group and non-CI-AKI group.In order to establish a CI-AKI risk score model and make initial verification,all patients were divided chronologically into an establishment group and a validation group at a ratio of 2:1.The basic characteristics of the patients were analyzed in the establishment group,univariate and multivariate analysis were performed to identify the risk factors of CI-AKI in emergency PCI patients and to form a CI-AKI risk score model.The predictive performance of the model was verified in the validation group.Finally,the incidences and the incidence trend of composite endpoint events(including non-fatal myocardial infarction,revascularization,stroke and all-cause death)at 1 and 12 months follow-up after discharge were calculated and analyzed in the whole population of emergency PCI patients,CI-AKI group and non-CI-AKI group.The predictive value of CI-AKI score and stratification on clinical prognosis was explored.In the study,CI-AKI was defined as an increase in serum creatinine(SCr)≥44.2 μmol/L(0.5 mg/dl)above baseline within 7 days after exposure to contrast agent,excluding renal function impairment caused by other causes.Results:A total of 3564 patients were eventually included in the study.The overall incidence of CI-AKI is 6.40%(228/3564).The patients were divided into CI-AKI group(228 cases)and non-CI-AKI group(3336 cases).The total number of emergency PCI patients and the number of CI-AKI patients show increasing trend.The yearly incidences of CI-AKI range from 5.5%-7.7%during 6 years,showing no significant upward or downward trend(p=0.608).The age of the population and the proportion of patients with myocardial infarction(MI)history increased significantly;the proportions of smokers and patients with hyperlipidemia in the whole emergency PCI population decreased year by year.About laboratory examination,platelet(plt),big endothelin-1(big ET-1)and baseline SCr show significant increases,and white blood cell(WBC)count,fasting blood glucose,high-sensitive C-reactive protein(hs-CRP)and estimated glomerular filtration rate(eGFR)decreased significantly.The proportion of patients with emergency PCI using intro-aortic balloon pump(IABP)also decreased significantly;contrast volume shows significant increase.In order to establish a CI-AKI risk score model and make preliminary verification,all patients were divided chronologically into an establishment group(2376 cases)and a validation group(1188 cases).In the establishment group,the incidence of CI-AKI is 6.61%(157/2376).The formed CI-AKI risk score model in the emergency PCI patients is constituted by 8 variables,the variables and scores of which are female(1 point),transient ischemic attack(TIA)/stroke history(1 point),left ventricular ejection fraction(LVEF)level(1 point per level),big ET-1 level(1 point per level),eGFR level(1 point per level),IABP(1 point),left anterior descending(LAD)stenting(1 point)and diuretics usage(2 points).The patients with emergency PCI can be further stratified and divided into low-risk(3-6 points),intermediate-risk(7-10 points),and high-risk groups(≥11 points).The incidences of CI-AKI in different risk strata are 1.4%,11.9%,and 42.6%,showing significant increase(p<0.001).In the validation group,the incidence of CI-AKI is 5.98%(71/1188).The discrimination and calibration performance of the CI-AKI risk score model performed well in the validation group(slope=0.914,c-statistic=0.787,95%CI:0.731-0.844).The incidences of CI-AKI increased significantly as the increase of patient risk score and risk strata both in the establishment group and the validation group(p<0.001 for all).The overall incidences of composite endpoint events at 1 and 12 months follow-up after discharge in the emergency PCI population are 3.1%and 11.3%,respectively.The incidences of composite endpoint events in the CI-AKI group are significantly higher than in the non-CI-AKI group both at 1 and 12 months follow-up(8.8%vs 2.7%,p<0.001;20.6%vs 10.6%,p<0.001).The trend shows no significance in the incidences of composite endpoint events during 6 years in the whole population at 1 month follow-up after discharge;the incidences of composite endpoint events at 12 months follow-up show significant incresing trend(p=0.031).According to the CI-AKI risk score model,the incidences of CI-AKI,composite endpoint events at 1 and 12 months after discharge all show significant increases as the increases of CI-AKI risk score and stratification(p<0.001 for all).Conclusion:The numbers of emergency PCI patients and CI-AKI patients increase year by year,with the incidences of CI-AKI showing no upward or downword trend.The CI-AKI risk score model in the study consists of 8 simple clinical indicators,dividing emergency PCI patients into low-risk,intermediate-risk and high-risk groups.The model shows good predictive efficacy and can be used as a simple and accurate tool for CI-AKI risk assessment after emergency PCI procedures.The incidences of composite endpoint events at 12 months follow-up in the whole emergency PCI population show significant incresing trend.The incidences of CI-AKI,composite endpoint events at 1 and 12 months follow up after discharge increase as the increases of the CI-AKI risk score and stratification.Therefore,the clinical prognosis of emergency PCI patients can be assessed easily according to the CI-AKI risk score model.