Prognostic impact of acute kidney injury on one-year survival in patients undergoing high-risk PCI with Impella support

This multicenter study evaluated the prognostic impact of acute kidney injury (AKI) on one-year survival in patients undergoing Impella-supported high-risk percutaneous coronary intervention (hrPCI), and whether Impella use offers renal protection. A total of 470 patients from two independent cohorts were analyzed: the IMPELLA-PL group (n = 249, derivation cohort) and the Dresden group (n = 221, validation cohort). Patients with cardiogenic shock or chronic dialysis were not included. AKI-defined as a ≥ 0.5 mg/dL increase in serum creatinine within 72 h-occurred in 13.3% and 14.9% of patients, respectively, which was significantly lower than the predicted 26.1% risk based on the Mehran Risk Score. AKI was an independent predictor of one-year mortality in both the derivation (HR: 2.75; 95% CI: 1.11-6.82) and validation (HR: 2.16; 95% CI: 1.12-4.10) cohorts. Upfront Impella implantation and higher baseline glomerular filtration rate were independently associated with a reduced risk of AKI in both cohorts. The adverse effect of AKI on long-term survival was significant in males, but not in females. These findings indicate that although AKI remains a strong prognostic marker following hrPCI, early Impella support may mitigate this risk. The results also suggest potential sex-related differences in susceptibility to renal complications following complex coronary interventions.