Contemporary Methods for Predicting Acute Kidney Injury After Coronary Intervention

BACKGROUND Acute kidney injury (AKI) is the most common complication after percutaneous coronary intervention (PCI). Accurately estimating patients' risks not only creates a means of benchmarking performance but can also be used prospectively to inform practice.OBJECTIVES The authors sought to update the 2014 National Cardiovascular Data Registry (NCDR) AKI risk model to provide contemporary estimates of AKI risk after PCI to further improve care.METHODS Using the NCDR CathPCI Registry, we identified all 2020 PCIs, excluding those on dialysis or lacking post-procedural creatinine. The cohort was randomly split into a 70% derivation cohort and a 30% validation cohort, and logistic regression models were built to predict AKI (an absolute increase of 0.3 mg/dL in creatinine or a 50% increase from preprocedure baseline) and AKI requiring dialysis. Bedside risk scores were created to facilitate prospective use in clinical care, along with threshold contrast doses to reduce AKI. We tested model calibration and discrimination in the validation cohort.RESULTS Among 455,806 PCI procedures, the median age was 67 years (IQR: 58.0-75.0 years), 68.8% were men, and 86.8% were White. The incidence of AKI and new dialysis was 7.2% and 0.7%, respectively. Baseline renal function and variables associated with clinical instability were the strongest predictors of AKI. The final AKI model included 13 vari-ables, with a C-statistic of 0.798 and excellent calibration (intercept =-0.03 and slope = 0.97) in the validation cohort.CONCLUSIONS The updated NCDR AKI risk model further refines AKI prediction after PCI, facilitating enhanced clinical care, benchmarking, and quality improvement. (J Am Coll Cardiol Intv 2023;16:2294-2305) (c) 2023 by the American College of Cardiology Foundation.