Advancing Early Detection of PCI-Related Renal Injury Based on Novel Biomarkers in Patients With Acute Coronary Syndrome

Objective To evaluate the predictive value of novel biomarkers for early detection of renal function injury following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome.Material and methods A prospective observational study was conducted, enrolling 326 patients with acute coronary syndrome who underwent PCI at Zhangjiakou First Hospital from January to December 2024. Patients were divided into acute kidney injury (AKI) group (n=52) and non-AKI group (n=274) based on whether AKI occurred within 48 h post-PCI. Blood samples were collected at pre-PCI baseline and at 2, 6, 12, and 24 h post-procedure to measure traditional renal markers (serum creatinine, blood urea nitrogen, estimated glomerular filtration rate, Cystatin C) and novel biomarkers (neutrophil gelatinase-associated lipocalin [NGAL], kidney injury molecule-1 [KIM-1], interleukin-18 [IL-18], tissue inhibitor of metalloproteinases-2 [TIMP2], insulin-like growth factor-binding protein 7 [IGFBP7], liver-type fatty acid-binding protein [L-FABP], receptor-interacting protein kinase 3 [RIPK3], and N-acetyl-β-D-glucosaminidase [NAG]). Receiver operating characteristic (ROC) curves were used to assess the predictive value of biomarkers. Multivariate logistic regression analysis was performed to identify independent predictors of AKI.Results AKI occurred in 52 (16 %) patients. Traditional markers showed no difference between groups within 12 h post-PCI, with differences emerging only at 24 h (p<0.001). Novel biomarkers demonstrated inter-group differences at 24 h (p<0.001), with TIMP2, IGFBP7, L-FABP, RIPK3, and NAG showing elevated concentrations in the AKI group as early as 2 h post-PCI (all p<0.001). The novel biomarker combination demonstrated superior predictive performance (AUC 0.89, 95 % CI 0.84-0.94) compared to traditional markers (AUC 0.71, 95 % CI 0.65-0.77, p<0.001), with NGAL showing the highest individual predictive value (AUC 0.85, 95 % CI 0.79-0.91). Multivariate analysis revealed that elevated NGAL >150 ng / ml at 2 h post-PCI was the strongest independent predictor of AKI (OR 3.8, 95 % CI 2.1-6.9, p<0.001). The AKI group had longer hospital stays (8.5±3.2 days vs 5.2±2.1 days), higher rates of major adverse cardiac events (18.5 % vs 7.3 %), and increased 30 day mortality (5.8 % vs 1.5 %) compared to the non-AKI group (all p<0.01).Conclusion Novel renal injury biomarkers, particularly NGAL, KIM-1, IL-18, along with TIMP2, IGFBP7, L-FABP, RIPK3, and NAG, provide superior early detection of post-PCI AKI compared to traditional markers, with abnormal elevation detectable as early as 2 h post-procedure. Elevated NGAL at 2 h post-PCI emerged as the strongest independent predictor of AKI occurrence. Integration of novel biomarker monitoring into routine post-PCI care would facilitate early identification of high-risk patients and timely implementation of renoprotective strategies.