Background: Severe coronary artery disease (CAD) is increasing and multimorbid patients are at high operative risk and more frequently offered for coronary high-risk interventions (HRI). Acute kidney injury (AKI) is one important complication due to multimorbidity, nephrotoxicity of contrast agents and limited hemodynamics during coronary procedure. Especially patients with heart failure (HF) are thought to be at higher risk for AKI. The aim of this study was to analyze the role of HF as a predictor for AKI in patients undergoing HRI.

Methods: In a 3-year follow-up between 2017 and 2020 a total of 367 patients underwent HRI according to NOVA-HRI algorithm. Patients with extracorporeal membrane oxygenation and cardiogenic shock were excluded from the analysis. 292 HF patients were classified into three subgroups [HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), HF with preserved ejection fraction (HFpEF)] based on current ESC guideline. All patients were investigated for occurrence and severity of AKI according current KDGIO recommendations.

Results: The overall occurrence of AKI was 10.6% (n=39). Remarkably, AKI occurred solely (100%) in patients with HF (p<0.001). In further analysis, AKI was more frequent in patients with HFrEF 20.0% vs. HFpEF 8.7% (p<0.05) but not between HFrEF 20.0% vs. HFmrEF 16.2% (p>0.05). Overall occurrence of severe AKI (AKI stage II + III) was low with 1.4% and without significant difference for HFrEF 4.0% vs. HFpEF 0.7%, (p=0.093) and HFmrEF 1.5% vs. HFpEF 0.7%, (p=0.608). There was no significant difference for occurrence of AKI in HF patients with moderate to severe chronic kidney disease (CKD) stage ≥ 3 comparing HFrEF 26.7% vs. HFpEF 13.7%, (p=0.112) and HFmrEF 23.3% vs. HFpEF 13.7%, (p=0.269). The amount of used contrast agent did not differ between subgroups. The use of percutaneous micro-axial left ventricular assist device (Impella®) showed significantly (p<0.05) lower rates for occurrence of AKI in HFrEF patients (with support 12.0% vs. without support 24.4%) and HFpEF patients (with support 7.1% vs. without support 29.6%). 

Conclusion: Patients with HF undergoing HRI were at higher risk for AKI. The use of percutaneous left ventricular assist device was associated with lower rates of AKI in HF patients.