Terumo’s ePrism Platform Studied for AKI Prevention During Coronary Angiography

November 9, 2022—Terumo Medical Corporation recently announced the publication of a study demonstrating that patients at high risk for acute kidney injury (AKI), the most common complication of percutaneous coronary intervention (PCI), had a significant reduction in AKI when cardiologists used Terumo Health Outcomes’ (THO) ePrism clinical decision support (CDS) software platform. THO is a division of Terumo Medical Corporation.

The ePrism CDS platform’s risk model predicts an individual patient’s risk for AKI and establishes patient-specific contrast limits to help guide safer PCI. With this information, clinicians can make informed, preprocedure treatment decisions and modify their approaches during treatment to minimize risk and improve outcomes.

The study, “Effect of Clinical Decision Support With Audit and Feedback on Prevention of Acute Kidney Injury in Patients Undergoing Coronary Angiography, A Randomized Clinical Trial” was published by Matthew T. James, MD, et al in JAMA: Journal of the American Medical Association (2022;328:839-849).

According to the company, the study included 31 invasive cardiologists from three cardiac catheterization laboratories in Alberta, Canada, who performed 7,820 procedures in 7,106 patients with a predicted AKI risk > 5%.

During the intervention period, cardiologists received educational outreach, computerized CDS on contrast volume and hemodynamic-guided intravenous fluid targets, and audit and feedback. During the control period, cardiologists provided usual care and did not receive the intervention training or tools. The primary outcome was AKI. There were 12 secondary outcomes, including contrast volume, intravenous fluid administration, and major adverse cardiovascular and kidney events. The analyses were conducted using time-adjusted models, advised the company.

Terumo reported that when ePrism was used, the proportion of procedures exceeding the safe contrast limits was reduced from 51.7% to 38.1%.

Study investigator John A. Spertus, MD, who is Professor of Medicine at the University of Missouri-Kansas City in Kansas City, Missouri, commented in Terumo’s press release, “Contrast-associated AKI is the most common complication of coronary angiography and PCI, and contributes to higher costs for health care systems and negative outcomes for patients. By incorporating ePrism to define ‘safe’ contrast limits for each individual patient, coupled with protocol-driven hydration, physicians were able to deliver much safer care. Using tools like ePrism to improve outcomes represents the future of precision medicine in routine clinical practice.”

Michael J. Martinelli, MD, who is Chief Medical Officer of Terumo Medical Corporation, stated in the press release, “The 3-year randomized study shows the benefits of the THO ePrism platform to strategically target the high-risk portion of the population. For many cardiovascular service line programs, the rate of reduction in AKI shown in this study, using ePrism technology, can improve their hospitals’ quality performance metrics from middle to top decile. This can result in lower costs to the hospital and better outcomes for patients.”