Abstract 4368072: CT Coronary Angiography vs Cardiac Catheterization and risk of Acute Kidney Injury – Comparative study

Backround: CT coronary angiography (CTCA) and invasive coronary angiography (ICA) are widely used to evaluate coronary artery disease (CAD). Both involve iodinated contrast, which may cause contrast-induced acute kidney injury (CI-AKI), particularly in high-risk patients. This study compared the incidence of AKI following CTCA versus ICA in hospitalized patients with symptomatic CAD. Methods: We conducted a retrospective cohort study using the TriNetX electronic health record network (2010–2025). Patients were identified using ICD-10 and CPT codes. Inclusion criteria were hospitalized adults with CAD and angina who underwent CTCA or diagnostic cardiac catheterization. Patients with myocardial infarction, prior revascularization, or end-stage renal disease were excluded. Patients were placed into mutually exclusive cohorts based on the procedure performed. The primary outcome was AKI within 1–4 days post-procedure. Propensity score matching (1:1) was used to balance baseline characteristics. Results: A total of 160,111 patients underwent CTCA and 88,081 underwent cardiac catheterization. After matching, 72,946 patients per group were analyzed. AKI occurred in 0.64% of CTCA patients vs. 1.29% of ICA patients. CTCA was associated with significantly lower odds of AKI (OR 0.496; 95% CI, 0.440–0.556) and an absolute risk reduction of 0.64% (p < 0.001). Conclusion: Among hospitalized patients with angina and Coronary artery disease, CT Coronary Angiography was associated with a significantly lower risk of Acute kidney injury compared to diagnostic catheterization. While absolute rates were low, the difference may reflect reduced invasiveness and contrast exposure with CT Coronary Angiography. These findings suggest CT Coronary Angiography may be a safer initial diagnostic option in coronary artery disease patients at increased risk for renal complications.