This post was authored by Thomas T. Tsai, MD, MSc, FACC, member of the NCDR Science and Quality Oversight Committee and steering committee chair of the PVI Registry.

A paper detailing the development of a new risk model of acute kidney injury (AKI) in patients undergoing percutaneous coronary intervention (PCI) was recently published in the Journal of the American Heart Association. The study, conducted by myself and several colleagues, applied data from the ACC’s NCDR CathPCI Registry to develop this viable tool, which will potentially aid clinicians in counseling patients undergoing PCI regarding the risk of acute kidney injury, identify patients for preventative strategies, and support local quality improvement efforts.

Through this study, we aimed to develop risk models for predicting AKI and AKI requiring dialysis (AKI-D) after PCI to support quality assessment and the use of preventative strategies. Data from 947,012 consecutive PCI patients and 1,253 sites participating in the CathPCI Registry between mid-2009 and mid-2011 were used to develop the model, with 70 percent randomly assigned to a derivation cohort and 30 percent for validation. AKI occurred in 7.33 percent of the derivation and validation cohorts. Eleven variables were associated with AKI: older age, baseline renal impairment (categorized as mild, moderate, and severe), prior cerebrovascular disease, prior heart failure, prior PCI, presentation (non-ACS vs. NSTEMI vs. STEMI), diabetes, chronic lung disease, hypertension, cardiac arrest, anemia, heart failure on presentation, balloon pump use, and cardiogenic shock. STEMI presentation, cardiogenic shock, and severe baseline CKD were the strongest predictors for AKI. The full model showed good discrimination in the derivation and validation cohorts and identical calibration. The AKI-D model had even better discrimination and good calibration.

We concluded that the NCDR AKI prediction models can successfully risk-stratify patients undergoing PCI. The result was a “robust tool for predicting AKI and AKI-D in patients undergoing PCI. Use of these models for national quality improvement efforts, personalizing the education of patients about the risks of treatment and to adjust the technical approach to PCI may all lead to safer, higher quality care and should be tested in prospective studies.”

The NCDR’s Annual Conference, NCDR.15, will be held March 12 – 13, immediately prior to the ACC’s 64th Annual Scientific Session in San Diego, CA. The two-day conference is expected to bring more than 900 registry professionals, quality experts, cardiovascular administrators and physicians from across the country together for registry-based education and networking. Registry-specific workshops will examine difficult data elements, metrics, expanded uses for data and interpreting outcome reports, while physician and administrator-focused breakout sessions will cover topics such as engaging fellow physicians and administrators, optimizing data quality, implementing quality improvement and the future of clinical registries and electronic health records. More information can be found at NCDR.com/AnnualConference.

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