Renal function-adjusted contrast volume redefines the baseline estimation of contrast-induced @entity810 risk in XXXX undergoing primary percutaneous coronary intervention.

@entity470 @entity1 @entity8 @entity810
BACKGROUND: Age, estimated @entity8 ( @entity470 ), and ejection fraction are preprocedural predictors of contrast-induced @entity810 (CI-AKI) after primary percutaneous coronary intervention. The effect of renal function-adjusted contrast volume (CV) remains not totally explored, and a threshold has not yet been established. METHODS AND RESULTS: Logistic regression and receiver-operating characteristic curve analyses were used to assess whether CV/ @entity470 was an independent predictor of CI-AKI. The increased discriminative value of CV/ @entity470 over the preprocedural model based on age, @entity470 , and ejection fraction was examined using the net reclassification improvement analysis. Of 470 @entity1 enrolled, we observed 25 (5.3%) cases of CI-AKI. @entity1 with CI-AKI had received a higher renal function-adjusted CV (CV/ @entity470 3.62 versus 1.96; P<0.001), and CI-AKI incidence was higher (15%; P<0.001) in @entity1 in the highest quartile of CV/ @entity470 , corresponding to the cutoff indicated by the receiver-operating characteristic curve (>2.5; area under the curve, 0.77). At multivariable analysis, CV/ @entity470 above the cutoff (odds ratio, 5.57; P=0.002) remained an independent predictor of CI-AKI. The model with CV/ @entity470 demonstrated a statistically significantly net reclassification improvement of 0.23 (P=0.021) over the baseline preprocedural model, largely driven by a correct decrease in risk estimates for @entity1 not experiencing CI-AKI, with a likelihood ratio   (2) of 5.973 (P=0.029). CONCLUSIONS: CV remains a key risk factor for CI-AKI after primary percutaneous coronary intervention and our study supports the need for minimizing CV, independently from baseline preprocedural risk. A CV restricted to no more than twice and a half the baseline @entity470 might be valuable in reducing the risk of CI-AKI.
