Background: An increasing number of patients with severe coronary artery disease (CAD) are at high operative risk and more frequently offered for coronary high-risk interventions (HRI). One major complication after HRI is acute kidney injury (AKI) due to multimorbidity, nephrotoxicity of contrast agents and limited hemodynamics during procedure. Therefore, patients with heart failure (HF) especially with reduced left ventricular ejection fraction (LVEF) are thought to be at higher risk for AKI occurrence, greater severity and higher rates for initiation of renal replacement therapy (RRT). The aim of this study was to analyze the role of heart failure as a predictor for AKI in patients undergoing HRI.

Methods: Between 2016 and 2019, a total of 261 HF patients underwent HRI according to NOVA-HRI algorithm. Patients with extracorporeal membrane oxygenation and cardiogenic shock were excluded. HF patients were classified into three subgroups based on current ESC guideline [HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), HF with preserved ejection fraction (HFpEF)] and analyzed for occurrence and severity of AKI according current KDGIO recommendations

Results: AKI was overall observed in 13.8% (n=36). AKI was more frequent in patients with HFrEF 22.1% vs. HFpEF 7.8%, p<0.05 and HFmrEF 17.2% vs. HFpEF 7.8%, p<0.05. Patients with a moderate to severe chronic kidney disease (CKD ≥ stage 3) showed no significant difference for occurrence of AKI (HFrEF 30.0% vs. HFpEF 13.3%, p=0.06, HFmrEF 21.9% vs. HFpEF 13.3%, p=0.324). The amount of used contrast agent did not differ between subgroups. Overall occurrence of severe AKI (AKI stage II + III) was low with 1.9% and without significant difference (HFrEF 4.4% vs. HFpEF 0.8%, p=0.085; HFmrEF 1.6% vs. HFpEF 0.8%, p=0.611). Remarkably, the use of percutaneous micro-axial left ventricular assist device (Impella®) showed significantly lower rates for occurrence of AKI in HFrEF patients (with support: HFrEF 13.6% vs. HFpEF 13.3%, p=0.953; without support: HFrEF 26.1% vs. HFpEF 6.1%, p<0.05).

Conclusion: Patients with HFrEF undergoing HRI appear to be at higher risk for AKI. The use of percutaneous small axial left ventricular assist device was associated with a significantly lower rate of AKI in HFrEF patients.