Mehran R, Owen R, Chiarito M, et al. - Based on easily available variables from patients receiving percutaneous coronary intervention (PCI), a contemporary simple risk score was established that is capable of accurately discriminating the risk of contrast-associated acute kidney injury, the development of which is robustly linked with subsequent death.

• Contrast-associated acute kidney injury can be encountered post-PCI.

• Consecutive patients receiving PCI between Jan 1, 2012, and Dec 31, 2020, with available creatinine measurements both before and within 48 h post-procedure, were included; a total of 14,616 patients formed the derivation cohort (mean age 66·2 years, 29·2% female) and 5606 formed the validation cohort (mean age 67·0 years, 26·4% female).

• Model 1 involved only pre-procedural variables, whereas Model 2 also comprised procedural variables.

• Clinical presentation, estimated glomerular filtration rate, left ventricular ejection fraction, diabetes, haemoglobin, basal glucose, congestive heart failure, and age were the independent predictors of contrast-associated acute kidney injury in Model 1.

• Contrast volume, peri-procedural bleeding, no flow or slow flow post procedure, and complex PCI anatomy were the additional independent predictors in Model 2.

• A gradual increase in contrast-associated acute kidney injury occurrence in the derivation cohort was observed from the lowest to the highest of the four risk score groups in both models (2·3% to 34·9% in Model 1, and 2·0% to 38·8% in Model 2).

• Only slightly improved discrimination of the risk score was achived by including procedural variables in the model (C-statistic in the derivation cohort: 0·72 for Model 1 and 0·74 for model 2; in the validation cohort: 0·84 for Model 1 and 0·86 for Model 2).

• In contrast-associated acute kidney injury cases, a significant increase in the risk of 1-year deaths was witnessed (10·2% vs 2·5%; adjusted hazard ratio 1·76), which was mainly because of excess 30-day deaths.