Original title: Impact of Periprocedural Bleeding on Incidente of Constrast-Induced Acute Kidney Injury in patients treated with Percutaneous Coronary Intervention. Reference: Yohei Ohno, et al. J Am Coll Cardiol 2013;62:1260-6
Contrast induced acute kidney injury (CI-AKI) is a serious complication associated to higher morbimortality rates and higher costs, but its correlation to bleeding remains controversial. This study included 2646 patients undergoing PCI; 315 (12%) presented CI AKI.
Patients were divided in 5 groups according to hemoglobin variation after PCI (Hb): Group A showed no change in Hb levels (290 patients), B: a decrease in Hb 3 g/dl (244 patients). There were no differences in baseline characteristics between the groups.
Kidney injury was associated to cardiac insufficiency CF III or IV, infarction with ST segment elevation, as well as a greater decrease in HB levels (odds ratio 2.23, IC 95% 1.37 to 3.63 p=0.001). CI-AKI patients presented higher rates of mortality compared to stable patients, as well as a composite of heart failure, cardiogenic shock, death, major bleeding and need of transfusion.
There was a significative correlation between HB level decrease and the events rate that, globally, resulted in 12%. Each group separately showed different rates: A 6%, B 8%, C 11%, D 17% y E 26% (p<0.001). Minor bleeding did not have significant impact.
Conclusion:
Periprocedural bleeding was significantly associated with CI-AKI, with CI-AKI incidence correlating with bleeding severity. These patients presented high risk of in-hospital mortality.
Comment:
It is known that kidney injury is a marker of bad evolution. This analysis also shows that bleeding may cause kidney injury after PCI and, in addition, it marks a bad evolution. It is important to remember the transradial approach reduces major bleeding events and, hence, should be the first choice not only for PC interventions but also for catheterizations.
Courtesy of Dr Carlos Fava,
Interventional cardiologist
Favaloro Foundation
Buenos Aires – Argentina
Dr. Carlos Fava para SOLACI.ORG
