Acute kidney injury following Impella-supported high-risk PCI significantly predicted 1-year mortality in males (HR 2.24; 95% CI 1.26-3.98) but not in females.
Cohort (n=470)
Sí
Does acute kidney injury impact 1-year survival differently in males and females undergoing high-risk percutaneous coronary interventions with Impella support?
In patients undergoing Impella-supported high-risk PCI, AKI is a significant predictor of 1-year mortality in males but not females, and the overall incidence of AKI is lower than predicted by standard risk scores.
Estimación del efecto: HR 2.24 (95% CI 1.26-3.98)
valor p: p=<0.01
Abstract Background Acute kidney injury (AKI) is a serious complication of high-risk percutaneous coronary interventions (hrPCI). The use of the Impella pump has been suggested to mitigate the risk of AKI during hrPCI. Purpose To investigate the prognostic impact of AKI on survival and assess the potential protective effects of Impella against AKI in males and females undergoing complex coronary interventions. Methods A total of 470 patients (373 males) undergoing Impella-supported hrPCI from two registries were analyzed: 249 patients (218 males) from the IMPELLA-PL registry, involving 22 Polish centres, and 221 patients (155 males) from a registry at a major centre in Germany. AKI was defined as an increase in serum creatinine of ≥0.5 mg/dL or ≥25% from baseline within 72 hours post-hrPCI, corresponding to the criteria used in the Mehran risk score. The primary outcome was the impact of AKI on 1-year survival, while the secondary outcome was the observed prevalence of AKI post-hrPCI compared to the predicted risk based on the Mehran risk score, analyzed separately for males and females. Results During the 1-year follow-up, 86 males (23.1%) and 12 females (12.4%) died (p = 0.08, log-rank test). AKI occurred in 53 of 373 males (14.2%) and 13 of 97 females (13.4%) (p = 1). In males, AKI was a significant predictor of 1-year mortality (HR: 2.24, 95% CI: 1.26–3.98); however, in females, AKI was not significantly associated with mortality (HR: 2.36, 95% CI: 0.41–13.44) (Fig. 1). Analyses were adjusted for age, baseline creatinine level, and left ventricular ejection fraction. Internal validation using bootstrapping (10,000 samples) confirmed that AKI remained a significant predictor of mortality in males (p 0.01) but not in females (p = 0.29). However, the interaction between sex and AKI in terms of 1-year survival was not statistically significant (p = 0.4). A sensitivity analysis using KDIGO criteria for AKI confirmed that AKI had a significant independent impact on 1-year survival in males (HR: 1.69, 95% CI: 1.01–2.84) but not in females (HR: 1.39, 95% CI: 0.34–5.76) (Fig. 2). The observed prevalence of AKI in males (14.2%) and females (13.4%) treated with the Impella pump was significantly lower than the predicted rate (26.1%) based on the Mehran risk score (p 0.001 and p 0.05, respectively). Conclusions AKI has a greater effect on 1-year mortality in males than in females, independently of age, baseline renal function, and left ventricular function. High-risk PCI with Impella support is associated with a lower risk of AKI than predicted by the Mehran risk score, suggesting a potential renal protective effect of the microaxial pump.Fig. 1.AKI impact on survival. Fig. 2.Sensitivity analysis (KDIGO).
Sacha et al. (Sat,) conducted a cohort in High-risk percutaneous coronary interventions (hrPCI) (n=470). Acute kidney injury (AKI) vs. No AKI was evaluated on Impact of AKI on 1-year survival (HR 2.24, 95% CI 1.26-3.98, p=<0.01). Acute kidney injury following Impella-supported high-risk PCI significantly predicted 1-year mortality in males (HR 2.24; 95% CI 1.26-3.98) but not in females.