{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T01:36:38Z","timestamp":1775093798438,"version":"3.50.1"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,1,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Contrast\u2010associated acute kidney injury (CA\u2010AKI) is associated with substantial morbidity and may be prevented by using less contrast during percutaneous coronary intervention (PCI). However, tools for determining safe contrast volumes are limited. We developed risk models to tailor safe contrast volume limits during PCI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Using data from all PCIs performed at 18 hospitals from January 2015 to March 2018, we developed logistic regression models for predicting CA\u2010AKI, including simpler models (\u201cpragmatic full,\u201d \u201cpragmatic minimum\u201d) using only predictors easily derivable from electronic health records. We prospectively validated these models using PCI data from April 2018 to December 2018 and compared them to preexisting safe contrast models using the area under the receiver operating characteristic curve (AUC). The model derivation data set included 20\u00a0579 PCIs with 2102 CA\u2010AKI cases. When applying models to the separate validation data set (5423 PCIs, 488 CA\u2010AKI cases), prior safe contrast limits (5*Weight\/Creatinine, 2*CreatinineClearance) were poor measures of safety with accuracies of 53.7% and 56.6% in predicting CA\u2010AKI, respectively. The full, pragmatic full, and pragmatic minimum models performed significantly better (accuracy, 73.1%, 69.3%, 66.6%; AUC, 0.80, 0.76, 0.72 versus 0.59 for 5\u00a0*\u00a0Weight\/Creatinine, 0.61 for 2*CreatinineClearance). We found that applying safe contrast limits could meaningfully reduce CA\u2010AKI risk in one\u2010quarter of patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Compared with preexisting equations, new multivariate models for safe contrast limits were substantially more accurate in predicting CA\u2010AKI and could help determine which patients benefit most from limiting contrast during PCI. Using readily available electronic health record data, these models could be implemented into electronic health records to provide actionable information for improving PCI safety.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.018890","type":"journal-article","created":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T10:31:06Z","timestamp":1608114666000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Refining Safe Contrast Limits for Preventing Acute Kidney Injury After Percutaneous Coronary Intervention"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5782-7437","authenticated-orcid":false,"given":"Neal","family":"Yuan","sequence":"first","affiliation":[{"name":"Smidt Heart InstituteCedars\u2010Sinai Medical Center Los Angeles CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalid","family":"Latif","sequence":"additional","affiliation":[{"name":"Biome Analytics San Francisco CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick G.","family":"Botting","sequence":"additional","affiliation":[{"name":"Smidt Heart InstituteCedars\u2010Sinai Medical Center Los Angeles CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaron","family":"Elad","sequence":"additional","affiliation":[{"name":"Smidt Heart InstituteCedars\u2010Sinai Medical Center Los Angeles CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4006-6760","authenticated-orcid":false,"given":"Steven M.","family":"Bradley","sequence":"additional","affiliation":[{"name":"Minneapolis Heart Institute and Minneapolis Heart Institute FoundationAbbott Northwestern Hospital Minneapolis MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teryl K.","family":"Nuckols","sequence":"additional","affiliation":[{"name":"Department of MedicineCedars\u2010Sinai Medical Center Los Angeles CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4977-036X","authenticated-orcid":false,"given":"Susan","family":"Cheng","sequence":"additional","affiliation":[{"name":"Smidt Heart InstituteCedars\u2010Sinai Medical Center Los Angeles CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0587-1572","authenticated-orcid":false,"given":"Joseph E.","family":"Ebinger","sequence":"additional","affiliation":[{"name":"Smidt Heart InstituteCedars\u2010Sinai Medical Center Los Angeles CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000659"},{"key":"e_1_3_1_3_2","first-page":"1424","article-title":"Report from 4 ACC national cardiovascular data registries","volume":"2017","author":"Masoudi FA","year":"2016","unstructured":"Masoudi FA, Ponirakis A, de Lemos JA, Jollis JG, Kremers M, Messenger JC, Moore JWM, Moussa I, Oetgen WJ, Varosy PD, et al. Report from 4 ACC national cardiovascular data registries. J Am Coll Cardiol. 2016;2017:1424\u20131426.","journal-title":"J Am Coll Cardiol"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(97)00150-2"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000016043.87291.33"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfl213"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.114.002475"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.20316"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2006030301"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2004.03.008"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.3111\/200710119134"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h4395"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2011-000041"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.114.000903"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfs602"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.04.055"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2012-303379"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001380"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc5713"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1080\/02841850802050762"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.4070\/kcj.2011.41.5.265"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(89)90437-3"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.05.023"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.16021"},{"key":"e_1_3_1_25_2","first-page":"176","article-title":"Ultra\u2010low contrast percutaneous coronary intervention to minimize the risk for contrast\u2010induced acute kidney injury in patients with severe chronic kidney disease","volume":"31","author":"Azzalini L","year":"2019","unstructured":"Azzalini L, Laricchia A, Regazzoli D, Mitomo S, Hachinohe D, Bellini B, Demir OM, Poletti E, Maccagni D, Colombo A. Ultra\u2010low contrast percutaneous coronary intervention to minimize the risk for contrast\u2010induced acute kidney injury in patients with severe chronic kidney disease. J Invasive Cardiol. 2019;31:176\u2013182.","journal-title":"J Invasive Cardiol"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.07.043"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.03.058"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.22828"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.114.001545"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12928-014-0245-9"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.114.001859"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1159\/000339789"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1805256"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1111\/joic.12482"},{"key":"e_1_3_1_35_2","unstructured":"National Cardiovascular Data Registry Committee . CathPCI: Acute Kidney Injury (risk\u2010adjusted) Specifications and Testing Overview. Available at https:\/\/www.ncdr.com\/WebNCDR\/docs\/default\u2010source\/ncdr\u2010general\u2010documents\/cathpci_kidney\u2010injury\u2010overview_comment\u2010period.pdf?sfvrsn=2. Accessed February 12 2020."}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.120.018890","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:59:33Z","timestamp":1715597973000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.120.018890"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,5]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1,5]]}},"alternative-id":["10.1161\/JAHA.120.018890"],"URL":"https:\/\/doi.org\/10.1161\/jaha.120.018890","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,5]]},"assertion":[{"value":"2020-08-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e018890"}}