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Refining Safe Contrast Limits for Preventing Acute Kidney Injury After Percutaneous Coronary Intervention.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2021 Jan 05; Vol. 10 (1), pp. e018890. Date of Electronic Publication: 2020 Dec 16. - Publication Year :
- 2021
-
Abstract
- Background Contrast-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 Results Using 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. Conclusions Compared 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.
- Subjects :
- Aged
Coronary Disease surgery
Dose-Response Relationship, Drug
Electronic Health Records statistics & numerical data
Female
Humans
Male
Predictive Value of Tests
Prognosis
Reproducibility of Results
Acute Kidney Injury chemically induced
Acute Kidney Injury prevention & control
Contrast Media administration & dosage
Contrast Media adverse effects
Decision Support Techniques
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention methods
Risk Adjustment methods
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 10
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 33325246
- Full Text :
- https://doi.org/10.1161/JAHA.120.018890