The influence of timing of coronary angiography on acute kidney injury in out-of-hospital cardiac arrest patients: a retrospective cohort study

Gladys N. Janssens, Joost Daemen, Jorrit S. Lemkes, Eva M. Spoormans, Dieuwertje Janssen, Corstiaan A. den Uil, Lucia S.D. Jewbali, Ton A.C.M. Heestermans, Victor A.W.M. Umans, Frank R. Halfwerk, Albertus Beishuizen, Joris Nas, Judith Bonnes, Peter M. van de Ven, Albert C. van Rossum, Paul W.G. Elbers, Niels van Royen*

*Corresponding author for this work

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Abstract

Background: Acute kidney injury (AKI) is a frequent complication in cardiac arrest survivors and associated with adverse outcome. It remains unclear whether the incidence of AKI increases after the post-cardiac arrest contrast administration for coronary angiography and whether this depends on timing of angiography. Aim of this study was to investigate whether early angiography is associated with increased development of AKI compared to deferred angiography in out-of-hospital cardiac arrest (OHCA) survivors. Methods: In this retrospective multicenter cohort study, we investigated whether early angiography (within 2 h) after OHCA was non-inferior to deferred angiography regarding the development of AKI. We used an absolute difference of 5% as the non-inferiority margin. Primary non-inferiority analysis was done by calculating the risk difference with its 90% confidence interval (CI) using a generalized linear model for a binary outcome. As a sensitivity analysis, we repeated the primary analysis using propensity score matching. A multivariable model was built to identify predictors of acute kidney injury. Results: A total of 2375 patients were included from 2009 until 2018, of which 1148 patients were treated with early coronary angiography and 1227 patients with delayed or no angiography. In the early angiography group 18.5% of patients developed AKI after OHCA and 24.1% in the deferred angiography group. Risk difference was − 3.7% with 90% CI ranging from − 6.7 to − 0.7%, indicating non-inferiority of early angiography. The sensitivity analysis using propensity score matching showed accordant results, but no longer non-inferiority of early angiography. The factors time to return of spontaneous circulation (odds ratio [OR] 1.12, 95% CI 1.06–1.19, p < 0.001), the (not) use of angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (OR 0.20, 95% CI 0.04–0.91, p = 0.04) and baseline creatinine (OR 1.05, 95% CI 1.03–1.07, p < 0.001) were found to be independently associated with the development of AKI. Conclusions: Although AKI occurred in approximately 20% of OHCA patients, we found that early angiography was not associated with a higher AKI incidence than a deferred angiography strategy. The present results implicate that it is safe to perform early coronary angiography with respect to the risk of developing AKI after OHCA.

Original languageEnglish
Article number12
JournalAnnals of Intensive Care
Volume12
Issue number1
DOIs
Publication statusPublished - 11 Feb 2022

Bibliographical note

Funding Information:
This work was supported by unrestricted research grants from the Netherlands Heart Institute, Biotronik and AstraZeneca.

Funding Information:
Prof. Dr. van Royen reports research grants from AstraZeneca, Abbott, Philips, Biotronik and an honorarium from Medtronic. Dr. Lemkes reports grants from Biotronik and Astrazeneca, during the conduct of the study. All other authors declare no competing interests with regard to the study.

Publisher Copyright:
© 2022, The Author(s).

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