We included all Alberta residents 66 years of age or older hospitalized with an ACS who underwent coronary angiography from November 1, 2002, to November 30, 2008, and survived at least 120 days after hospital discharge. ![]() Only nonionic iodinated radio-contrast agents were used in coronary angiography, with the choice of low- or iso-osmolar radio-contrast agents and prophylaxis strategies for AKI made by the treating physicians. The APPROACH database prospectively collects demographics, clinical data, and vital statistics on all patients receiving a coronary angiogram in the province of Alberta in Canada ( 21). We identified the study cohort from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. We hypothesized that those with AKI would be less likely to receive these medications after hospitalization with an ACS but that use of these medications would be associated with improved survival. We also examined the association between the use of these medications and subsequent survival among individuals who had experienced AKI. Given this knowledge gap, we examined the relationship between contrast-associated AKI and subsequent cardiovascular medication use in elderly patients after an acute coronary syndrome (ACS). Although contrast-associated AKI could also influence physician’s decisions to prescribe these medications after a cardiovascular event because of their hemodynamic effects or potential for nephrotoxicity ( 18– 20), little is known about the association between AKI and the use of these medications in patients with cardiovascular disease. However, these medications are prescribed 30%–74% less frequently in some high-risk groups, suggesting a risk-treatment paradox that includes the elderly and those with comorbidities ( 13– 17). Several medications, including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, and statins, have been shown to lower cardiovascular morbidity and mortality in a wide range of populations with cardiovascular disease ( 7– 12). Although kidney function returns to baseline in the majority of individuals in this setting, contrast-associated AKI has been associated with adverse short- and long-term outcomes, including cardiovascular morbidity, ESRD, and mortality ( 3– 6). ![]() The use of each class of cardiovascular medication was associated with lower mortality, including among those who had experienced AKI.ĪKI occurs in 10%–11% of patients after percutaneous coronary angiography and is more frequent among the elderly and patients with diabetes mellitus, heart failure, and preexisting CKD ( 1, 2). ![]() These associations were consistently seen in patients with diabetes mellitus, heart failure, low baseline eGFR, and albuminuria 952 participants died during subsequent follow-up after hospital discharge (mean=3.1 years). Subsequent statin and β-blockers use within 120 days of hospital discharge was significantly lower among those with stages 2–3 AKI (adjusted odds ratio, 0.44 95% confidence interval, 0.31 to 0.64 and odds ratio, 0.46 95% confidence interval, 0.31 to 0.66, respectively). In multivariable logistic regression models, compared with participants without AKI, those with stages 1 and 2–3 AKI had lower odds of subsequent use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker within 120 days of hospital discharge (adjusted odds ratio, 0.65 95% confidence interval, 0.53 to 0.80 and odds ratio, 0.34 95% confidence interval, 0.23 to 0.48, respectively).
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