Impella support and acute kidney injury during high-risk percutaneous coronary intervention: The Global cVAD Renal Protection Study.
BACKGROUND
Protection against acute kidney injury (AKI) has been reported with the use of Impella during high-risk percutaneous coronary intervention (HR-PCI). We sought to evaluate this finding by determining the occurrence of AKI during Impella-supported HR-PCI in patients from the Global cVAD Study and compare this incidence with their calculated AKI risk at baseline.


METHODS AND RESULTS
In this prospective, multicenter study, we enrolled 314 consecutive patients. We included 223 patients that underwent nonemergent HR-PCI supported with Impella 2.5 or Impella CP and excluded those requiring hemodialysis prior to HR-PCI (19) and those with insufficient data (72). The primary outcome was AKI postprocedurally at 48 hr versus the predicted risk of AKI according to Mehran risk score. Logistic regression analysis determined predictors of AKI. Overall, 4.9% (11) of Impella-supported patients developed AKI (exclusively stage 1) at 48 hr versus a predicted rate of 21.9%, representing a 77.6% lower AKI rate (p < .0001). In this study, no Impella-supported patients required renal replacement therapy. Estimated glomerular filtration rate (ml/min/1.73 m2 ) alone predicted AKI (adjusted odds ratio [AOR]: 4.915; 95% confidence intervals [CI]: 1.02-23.53, p = .046), and increasing contrast had insignificant effects on AKI during high-risk PCI (AOR: 1.15; 95% CI: 0.87-1.51, p = .332). In patients not protected from AKI, the postprocedure incidence of AKI was not significantly greater and did not correlate with chronic kidney disease severity.


CONCLUSION
The incidence of AKI was lower during HR-PCI than expected from current risk models. Although further exploration of this finding is warranted, these data support a new protective strategy against AKI during HR-PCI.
['Flaherty|Michael P|MP|0000-0001-7255-4676', 'Moses|Jeffrey W|JW|', 'Westenfeld|Ralf|R|0000-0001-7058-3051', 'Palacios|Igor|I|', "O'Neill|William W|WW|", 'Schreiber|Theodore L|TL|', 'Lim|Michael J|MJ|', 'Kaki|Amir|A|', 'Ghiu|Ioana|I|', 'Mehran|Roxanna|R|']
D058186:Acute Kidney Injury D000368:Aged D000369:Aged, 80 and over D002170:Canada D003324:Coronary Artery Disease D005060:Europe D005260:Female D006353:Heart-Assist Devices D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D062645:Percutaneous Coronary Intervention D011446:Prospective Studies D065840:Protective Factors D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome D014481:United States
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