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Abstract: PO2105

Race Differences in Cardiovascular Events After Percutaneous Coronary Intervention-Induced AKI

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Lunyera, Joseph, Duke University School of Medicine, Durham, North Carolina, United States
  • Clare, Robert M., Duke Clinical Research Institute, Durham, North Carolina, United States
  • Chiswell, Karen, Duke Clinical Research Institute, Durham, North Carolina, United States
  • Scialla, Julia J., University of Virginia School of Medicine, Charlottesville, Virginia, United States
  • Pun, Patrick H., Duke Clinical Research Institute, Durham, North Carolina, United States
  • Thomas, Kevin L., Duke Clinical Research Institute, Durham, North Carolina, United States
  • Starks, Monique, Duke Clinical Research Institute, Durham, North Carolina, United States
  • Diamantidis, Clarissa Jonas, Duke University School of Medicine, Durham, North Carolina, United States
Background

AKI portends a higher risk of subsequent cardiovascular disease (CVD). Although racial differences in AKI incidence have been found, it is unclear if the risk of CVD events following AKI also varies by race.

Methods

We quantified racial differences in the association of AKI with CVD events 1-year following percutaneous coronary intervention (PCI), using the Duke Databank for Cardiovascular Disease (DDCD). The DDCD captured all patients who underwent PCI at Duke between January 1, 2003 and December 31, 2013 with a combination of structured (forms) and electronic health record (EHR) data. Patients were followed prospectively for CVD events. AKI was defined as ≥ 1.5-fold increase in serum creatinine from outpatient reference value before PCI to the peak value within 7 days post-PCI or a 0.3 mg/dl increase from the reference value within 48 hours. The primary outcome was a CVD composite including all-cause death, myocardial infarction, stroke, and revascularization. Cox models from date of AKI to outcome were adjusted for demographics, baseline cardiac comorbidities, medication use (RAAS inhibitors and NSAIDS), indication and urgency of PCI, and BP at PCI and number of stents placed.

Results

Among 9432 patients (median age 63y; 33% women; 75% white, 20% black), 865 (9%) developed AKI. Among 8699 patients with follow-up, the cumulative incidence of CVD at 1-year was 21%. After adjustment, AKI vs no AKI was associated with 1.84 greater hazards for the composite CVD outcome [95% confidence interval (CI) 1.62 to 2.10]. Compared to whites, other race (HR 0.79, 95% CI 0.63 to 0.99) but not black race (HR 1.07, 95% CI 0.95 to 1.20) was associated with lower risk of subsequent CVD. There was no interaction between race and AKI (p-interaction 0.216). Results were similar with individual components of the outcome.

Conclusion

AKI vs. no AKI following PCI is associated with greater risk for CVD events, regardless of race. Efforts to offset long-term consequences of AKI should target all patients undergoing PCI.

Funding

  • Private Foundation Support