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Impact of intravascular ultrasound-guided minimum-contrast coronary intervention on 1-year clinical outcomes in patients with stage 4 or 5 advanced chronic kidney disease. Cardiovasc Interv Ther 2018; 34:234-241. [DOI: 10.1007/s12928-018-0552-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
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102
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Denegri A, Mehran R, Holy E, Taramasso M, Pasotti E, Pedrazzini G, Moccetti T, Maisano F, Nietlispach F, Obeid S. Post procedural risk assessment in patients undergoing trans aortic valve implantation according to the age, creatinine, and ejection fraction-7 score: Advantages of age, creatinine, and ejection fraction-7 in stratification of post-procedural outcome. Catheter Cardiovasc Interv 2018; 93:141-148. [PMID: 30269398 DOI: 10.1002/ccd.27806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/30/2018] [Accepted: 07/12/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Post-procedural risk stratification based on renal function after trans aortic valve implantation (TAVI) was assessed by means of a modified age, creatinine, and ejection fraction (ACEF) score using the lowest glomerular filtration rate (GFR), obtained within 1 week after valve implantation. We refer to the score as ACEF-7 score. METHODS The Zurich- and Cardiocentro Ticino TAVI-Cohorts comprised of 424, and 137 patients, who were not on hemodialysis and had already survived the first post-procedural week. Zurich patients were stratified into tertiles of ACEF-7 score (ACEF-7Low ≤ 2.45 (n = 138), ACEF-7Mid 2.46-4.38 (n = 142), and ACEF-7High ≥ 4.39 (n = 144) and compared for survival using KM curves. Euroscore II, Society of Thoracic Surgeons (STS), and ACEF were also calculated at baseline in all patients and assessed for prognostic significance in predicting the primary outcome of 1-year all-cause mortality using univariate and multivariate Cox regression models. Results were then confirmed in the Cardiocentro cohort. RESULTS Six months (18.1% vs. 6.3% vs. 2.9% P < 0.001) and 1-year all-cause mortality (24.3% vs. 12.7% % vs. 5.8%, P < 0.001), as well as the composite of death or rehospitalization (35% vs. 20% vs. 11% P < 0.001) occurred significantly more frequently in the ACEF-7High compared to the other groups. Both Euroscore II and STS score were not predictors of mortality in our cohort. In a multivariate Cox regression model corrected for gender, Acute Kidney Injury, and baseline ACEF score, the ACEF-7 score was an independent predictor of 1-year all-cause mortality as a per point increment HR 1.512 [95% CI 1.227-1.862, P < 0.001] and as ACEF-7High (≥4.39); HR 5.541 [1.694-18.120]). In addition, the ACEF-7 tertiles showed a significant (P = 0.02) net reclassification improvement of 16% when compared to baseline tertiles of ACEF score, when assessing 1-year all-cause mortality. CONCLUSION Post-procedural risk stratification using the simple ACEF-7 score significantly better predicted long-term outcome than commonly used risk-scores. Practical implications could include contrast sparing and renal protection in high-risk patients, emphasizing the importance of preventative measures.
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Affiliation(s)
- Andrea Denegri
- University Heart Center, University Hospital, Zurich, Switzerland.,Cardiocentro Lugano, University of Zurich, Lugano, Switzerland.,Cardiology Unit and Laboratory of Cardiovascular Biology, IRCCS-AOU San Martino-IST University of Genova, Genoa, Italy
| | | | - Erik Holy
- University Heart Center, University Hospital, Zurich, Switzerland
| | | | - Elena Pasotti
- Cardiocentro Lugano, University of Zurich, Lugano, Switzerland
| | | | | | | | | | - Slayman Obeid
- University Heart Center, University Hospital, Zurich, Switzerland
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103
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Aoki T, Ishii H, Tanaka A, Suzuki S, Ichimiya S, Kanashiro M, Murohara T. Influence of chronic kidney disease and worsening renal function on clinical outcomes in patients undergoing primary percutaneous coronary intervention. Clin Exp Nephrol 2018; 23:182-188. [PMID: 30218297 DOI: 10.1007/s10157-018-1622-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The combined influence of CKD and worsening renal function (WRF) on clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been fully understood. METHODS We analyzed 443 patients diagnosed with AMI who underwent primary PCI. Based on their estimated glomerular filtration rate (eGFR), they were classified into two groups: a high eGFR group (eGFR ≥ 45 mL/min/1.73 m2, n = 381) and a low eGFR group (eGFR < 45 mL/min/1.73 m2, n = 63). WRF was defined as an increase in serum creatinine levels ≥ 0.3 mg/dL above the admission value during the course of hospitalization. The primary end-point was set as all-cause mortality. RESULTS WRF was observed in 88 patients (19.8%). The median follow-up duration was 769 (interquartile range 397-1314) days. The all-cause mortality rate was significantly lower in the high eGFR than in the low eGFR group (5.5 vs. 28.6%, respectively, at 1500 days, P < 0.001). In patients with WRF, the all-cause and cardiac mortality rates were significantly higher than in patients without WRF, and these results were consistent between the high and low eGFR sub-groups. Multivariate Cox proportional hazards model analysis showed that low eGFR and WRF remained independent predictors of all-cause mortality [(hazard ratio 2.61, 95% confidence interval 1.27-5.36, P = 0.009) and (hazard ratio 2.59, 95% confidence interval 1.34-5.01, P = 0.005), respectively]. CONCLUSIONS Both eGFR at baseline and WRF were observed to be important predictors of mortality in patients with AMI undergoing primary PCI. WRF showed a significant effect on mortality even in patients with high eGFR.
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Affiliation(s)
- Toshijiro Aoki
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoshi Ichimiya
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Masaaki Kanashiro
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Spitzer E, McFadden E, Onuma Y, Serruys PW. Reply: Following Renal Outcomes With Staging in Percutaneous Coronary Intervention Trials. JACC Cardiovasc Interv 2018; 11:1662-1663. [PMID: 30139478 DOI: 10.1016/j.jcin.2018.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 11/30/2022]
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105
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Leistner DM, Münch C, Steiner J, Erbay A, Riedel M, Gebhard C, Lauten A, Landmesser U, Stähli BE. Impact of acute kidney injury in elderly (≥80 years) patients undergoing percutaneous coronary intervention. J Interv Cardiol 2018; 31:792-798. [DOI: 10.1111/joic.12547] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/04/2018] [Accepted: 07/15/2018] [Indexed: 01/23/2023] Open
Affiliation(s)
- David M. Leistner
- Department of Cardiology; Charité-University Medicine Berlin; Campus Benjamin Franklin; Berlin Germany
- DZHK (German Centre for Cardiovascular Research); Partner Site Berlin; Berlin Germany
- Berlin Institute of Health (BIH); Berlin Germany
| | - Charlotte Münch
- Department of Cardiology; Charité-University Medicine Berlin; Campus Benjamin Franklin; Berlin Germany
- DZHK (German Centre for Cardiovascular Research); Partner Site Berlin; Berlin Germany
| | - Julia Steiner
- Department of Cardiology; Charité-University Medicine Berlin; Campus Benjamin Franklin; Berlin Germany
- DZHK (German Centre for Cardiovascular Research); Partner Site Berlin; Berlin Germany
| | - Aslihan Erbay
- Department of Cardiology; Charité-University Medicine Berlin; Campus Benjamin Franklin; Berlin Germany
- DZHK (German Centre for Cardiovascular Research); Partner Site Berlin; Berlin Germany
| | - Matthias Riedel
- Department of Cardiology; Charité-University Medicine Berlin; Campus Benjamin Franklin; Berlin Germany
- DZHK (German Centre for Cardiovascular Research); Partner Site Berlin; Berlin Germany
| | - Cathérine Gebhard
- Division of Cardiology and Angiology II; University Heart Center Freiburg-Bad Krozingen; Bad Krozingen Germany
| | - Alexander Lauten
- Department of Cardiology; Charité-University Medicine Berlin; Campus Benjamin Franklin; Berlin Germany
- DZHK (German Centre for Cardiovascular Research); Partner Site Berlin; Berlin Germany
| | - Ulf Landmesser
- Department of Cardiology; Charité-University Medicine Berlin; Campus Benjamin Franklin; Berlin Germany
- DZHK (German Centre for Cardiovascular Research); Partner Site Berlin; Berlin Germany
- Berlin Institute of Health (BIH); Berlin Germany
| | - Barbara E. Stähli
- Department of Cardiology; Charité-University Medicine Berlin; Campus Benjamin Franklin; Berlin Germany
- DZHK (German Centre for Cardiovascular Research); Partner Site Berlin; Berlin Germany
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Giustino G, Mehran R, Serruys PW, Sabik JF, Milojevic M, Simonton CA, Puskas JD, Kandzari DE, Morice MC, Taggart DP, Gershlick AH, Généreux P, Zhang Z, McAndrew T, Redfors B, Ragosta M, Kron IL, Dressler O, Leon MB, Pocock SJ, Ben-Yehuda O, Kappetein AP, Stone GW. Left Main Revascularization With PCI or CABG in Patients With Chronic Kidney Disease. J Am Coll Cardiol 2018; 72:754-765. [DOI: 10.1016/j.jacc.2018.05.057] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/26/2018] [Accepted: 05/11/2018] [Indexed: 01/22/2023]
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Development and Validation of Nomogram to Predict Acute Kidney Injury in Patients with Acute Myocardial Infarction Treated Invasively. Sci Rep 2018; 8:9769. [PMID: 29950662 PMCID: PMC6021383 DOI: 10.1038/s41598-018-28088-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/07/2018] [Indexed: 02/06/2023] Open
Abstract
To identify patients who are likely to develop contrast-induced acute kidney injury (CI-AKI) in patients with acute myocardial infarction (AMI), a nomogram was developed in AMI patients. Totally 920 patients with AMI were enrolled in our study. The discrimination and calibration of the model were validated. External validations were also carried out in a cohort of 386 AMI patients. Our results showed in the 920 eligible AMI patients, 114 patients (21.3%) developed CI-AKI in the derivation group (n = 534), while in the validation set (n = 386), 50 patients (13%) developed CI-AKI. CI-AKI model included the following six predictors: hemoglobin, contrast volume >100 ml, hypotension before procedure, eGFR, log BNP, and age. The area under the curve (AUC) was 0.775 (95% confidence interval [CI]: 0.732–0.819) in the derivation group and 0.715 (95% CI: 0.631–0.799) in the validation group. The Hosmer-Lemeshow test has a p value of 0.557, which confirms the model’s goodness of fit. The AUC of the Mehran risk score was 0.556 (95% CI: 0.498–0.615) in the derivation group. The validated nomogram provided a useful predictive value for CI-AKI in patients with AMI.
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108
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Go AS, Hsu CY, Yang J, Tan TC, Zheng S, Ordonez JD, Liu KD. Acute Kidney Injury and Risk of Heart Failure and Atherosclerotic Events. Clin J Am Soc Nephrol 2018; 13:833-841. [PMID: 29773712 PMCID: PMC5989674 DOI: 10.2215/cjn.12591117] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/22/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES AKI in the hospital is common and is associated with excess mortality. We examined whether AKI is also independently associated with a higher risk of different cardiovascular events in the first year after discharge. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a retrospective analysis of a cohort between 2006 and 2013 with follow-up through 2014, within Kaiser Permanente Northern California. We identified all adults admitted to 21 hospitals who had one or more in-hospital serum creatinine test result and survived to discharge. Occurrence of AKI was on the basis of Kidney Disease: Improving Global Outcomes diagnostic criteria. Potential confounders were identified from comprehensive inpatient and outpatient, laboratory, and pharmacy electronic medical records. During the 365 days after discharge, we ascertained occurrence of heart failure, acute coronary syndromes, peripheral artery disease, and ischemic stroke events from electronic medical records. RESULTS Among a matched cohort of 146,941 hospitalized adults, 31,245 experienced AKI. At 365 days postdischarge, AKI was independently associated with higher rates of the composite outcome of hospitalization for heart failure and atherosclerotic events (adjusted hazard ratio [aHR], 1.18; 95% confidence interval [95% CI], 1.13 to 1.25) even after adjustment for demographics, comorbidities, preadmission eGFR and proteinuria, heart failure and sepsis complicating the hospitalization, intensive care unit (ICU) admission, length of stay, and predicted in-hospital mortality. This was driven by an excess risk of subsequent heart failure (aHR, 1.44; 95% CI, 1.33 to 1.56), whereas there was no significant association with follow-up atherosclerotic events (aHR, 1.05; 95% CI, 0.98 to 1.12). CONCLUSIONS AKI is independently associated with a higher risk of cardiovascular events, especially heart failure, after hospital discharge.
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Affiliation(s)
- Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Epidemiology and Biostatistics and
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California; and
| | - Chi-yuan Hsu
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California; and
| | - Jingrong Yang
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Thida C. Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Sijie Zheng
- Division of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Juan D. Ordonez
- Division of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Kathleen D. Liu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California; and
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109
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Safe Hydration Volume to Prevent Contrast-induced Acute Kidney Injury and Worsening Heart Failure in Patients With Heart Failure and Preserved Ejection Fraction After Cardiac Catheterization. J Cardiovasc Pharmacol 2018; 70:168-175. [PMID: 28525419 DOI: 10.1097/fjc.0000000000000502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Few studies have investigated the efficacy and safety of hydration to prevent contrast-induced acute kidney injury (CI-AKI) and worsening heart failure (WHF) after cardiac catheterization in heart failure and preserved ejection fraction (HFpEF; HF and EF ≥50%) patients. We recruited 1206 patients with HFpEF undergoing cardiac catheterization with periprocedural hydration volume/weight (HV/W) ratio data and investigated the relationship between hydration volumes and risk of CI-AKI and WHF. Incidence of CI-AKI was not significantly reduced in individuals with higher HV/W [quartile (Q) 1, Q2, Q3, and Q4: 9.7%, 10.2%, 12.7%, and 12.2%, respectively; P = 0.219]. Multivariate analysis indicated that higher HV/W ratios were not associated with decreased CI-AKI risks [Q2 vs. Q1: odds ratio (OR), 0.95; Q3 vs. Q1: OR, 1.07; Q4 vs. Q1: OR, 0.92; all P > 0.05]. According to multivariate analysis, higher HV/W significantly increased the WHF risk (Q4 vs. Q1: adjusted OR, 8.13 and 95% confidence interval, 1.03-64.02; P = 0.047). CI-AKI and WHF were associated with a significantly increased risk of long-term mortality (mean follow-up, 2.33 years). For HFpEF patients, an excessively high hydration volume might not be associated with lower risk of CI-AKI but may increase the risk of postprocedure WHF.
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110
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Marenzi G, Cosentino N, Milazzo V, De Metrio M, Rubino M, Campodonico J, Moltrasio M, Marana I, Grazi M, Lauri G, Bonomi A, Barbieri S, Assanelli E, Dalla Cia A, Manfrini R, Ceriani R, Bartorelli A. Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia. J Am Heart Assoc 2018; 7:JAHA.117.008122. [PMID: 29654205 PMCID: PMC6015410 DOI: 10.1161/jaha.117.008122] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background In acute myocardial infarction, acute hyperglycemia is a predictor of acute kidney injury (AKI), particularly in patients without diabetes mellitus. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission. We investigated whether, in diabetic patients with acute myocardial infarction, the combined evaluation of acute and chronic glycemic levels may have better prognostic value for AKI than admission glycemia. Methods and Results At admission, we prospectively measured glycemia and estimated average chronic glucose levels (mg/dL) using glycosylated hemoglobin (HbA1c), according to the following formula: 28.7×HbA1c (%)−46.7. We evaluated the association with AKI of the acute/chronic glycemic ratio and of the difference between acute and chronic glycemia (ΔA−C). We enrolled 474 diabetic patients with acute myocardial infarction. Of them, 77 (16%) experienced AKI. The incidence of AKI increased in parallel with the acute/chronic glycemic ratio (12%, 14%, 22%; P=0.02 for trend) and ΔA−C (13%, 13%, 23%; P=0.01) but not with admission glycemic tertiles (P=0.22). At receiver operating characteristic analysis, the acute/chronic glycemic ratio (area under the curve: 0.62 [95% confidence interval, 0.55–0.69]; P=0.001) and ΔA−C (area under the curve: 0.62 [95% confidence interval, 0.54–0.69]; P=0.002) accurately predicted AKI, without difference in the area under the curve between them (P=0.53). At reclassification analysis, the addition of the acute/chronic glycemic ratio and ΔA−C to acute glycemia allowed proper AKI risk prediction in 16% of patients. Conclusions In diabetic patients with acute myocardial infarction, AKI is better predicted by the combined evaluation of acute and chronic glycemic values than by assessment of admission glycemia alone.
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Affiliation(s)
| | | | | | | | - Mara Rubino
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | | | - Marco Grazi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | | | | | | | | | | | - Antonio Bartorelli
- Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy
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Hatem R, Finn MT, Riley RF, Mathur M, Lombardi WL, Ali ZA, Karmpaliotis D. Zero contrast retrograde chronic total occlusions percutaneous coronary intervention: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:1-5. [PMID: 30370403 PMCID: PMC6177013 DOI: 10.1093/ehjcr/yty036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/28/2018] [Indexed: 11/24/2022]
Abstract
Introduction Percutaneous coronary intervention (PCI) in patients with advanced chronic kidney disease (CKD) is associated with a high risk of contrast-induced nephropathy and resulting progression of CKD to need for renal replacement therapy. Chronic total occlusions (CTO) PCI is increasingly utilized in the treatment of refractory stable angina and ischaemic heart failure. Recent studies have described the feasibility of ‘minimal’ or ‘zero’ contrast PCI by employing intravascular imaging and intra-coronary physiology to guide successful stent implantation with resolution of ischaemia. We extended these techniques to CTO lesions via the retrograde approach. Case presentation Two patients with estimated glomerular filtration rate ≤15 mL/min who presented with angina symptoms and had subsequent positive stress tests were referred for CTO-PCI. The patients had diagnostic angiography with minimal contrast. After a recovery period, the patients underwent successful retrograde zero contrast CTO-PCI with the use of adjunctive intravascular ultrasound imaging. Discussion The described reports are the first two successful attempts at zero contrast retrograde procedures and demonstrate the feasibility of imaging and physiology-guided retrograde PCI without contrast administration in two patients with significant coronary artery disease requiring intervention. When indicated, zero contrast PCI offers the ability to treat obstructive coronary disease without worsening renal function in patients with severe CKD.
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Affiliation(s)
- Raja Hatem
- Columbia University, 161 Fort Washington Avenue, 6th Floor, New York, NY, USA
- Cardiovascular Research Foundation, 1700 Broadway, 8th Floor, New York, NY, USA
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Boul Gouin O, Montréal, QC H4J 1C5, Canada
| | - Matthew T Finn
- Columbia University, 161 Fort Washington Avenue, 6th Floor, New York, NY, USA
- Cardiovascular Research Foundation, 1700 Broadway, 8th Floor, New York, NY, USA
| | - Robert F Riley
- Department of Cardiology, University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA, USA
| | - Moses Mathur
- Department of Cardiology, University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA, USA
| | - William L Lombardi
- Department of Cardiology, University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA, USA
| | - Ziad A Ali
- Columbia University, 161 Fort Washington Avenue, 6th Floor, New York, NY, USA
- Cardiovascular Research Foundation, 1700 Broadway, 8th Floor, New York, NY, USA
| | - Dimitri Karmpaliotis
- Columbia University, 161 Fort Washington Avenue, 6th Floor, New York, NY, USA
- Cardiovascular Research Foundation, 1700 Broadway, 8th Floor, New York, NY, USA
- Corresponding author. Tel: (212) 305-7060, Fax 212-305-0676, . This case report was reviewed by Joshua Chai and Dejan Milasinovic
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112
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Incidence, Predictors, and Impact on Six-Month Mortality of Three Different Definitions of Contrast-Induced Acute Kidney Injury After Coronary Angiography. Am J Cardiol 2018; 121:818-824. [PMID: 29397881 DOI: 10.1016/j.amjcard.2017.12.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/05/2017] [Accepted: 12/18/2017] [Indexed: 01/21/2023]
Abstract
We assessed incidence, predictors, and impact on 6-month mortality of contrast-induced acute kidney injury (CI-AKI) after coronary angiography with or without percutaneous coronary intervention in patients with acute coronary syndrome (ACS), according to 3 different CI-AKI definitions. Serum creatinine (sCr) was assessed at baseline and 48 to 72 hours after procedure to classify patients into 3 CI-AKI groups: Group 1: increase in sCR ≥25% over baseline but absolute increase <0.5 mg/dl; Group 2: absolute increase ≥0.5 mg/dl; Group 3: absolute increase ≥0.3 mg/dl or ≥50% over baseline. The association between CI-AKI and all-cause 6-month mortality was assessed using multivariate Cox regression. Among 1,002 patients included, median age was 68 [57 to 79] years. The sample had the following characteristics: 70% men, 25% diabetics, 22% had a history of myocardial infarction, 21% had baseline estimated glomerular filtration rate (as calculated by the Modification of Diet in Renal Disease) <60 ml/min/1.72 m2, 34% had ST-segment elevation myocardial infarction, 61% underwent percutaneous coronary intervention, and 43% had multivessel disease. Based on changes in sCr, 89 patients (8.9%) were classified in Group 1; 69 (6.9%) in Group 2; and 157 (15.7%) in Group 3, whereas sCr did not increase >25% in the remaining 844 (84.2%). CI-AKI was significantly associated with 6-month all-cause mortality using the definitions for Group 2 (hazard ratio 3.1, 95% confidence interval [CI] 1.5 to 6.6, p = 0.002) and Group 3 (hazard ratio 2.03, 95% CI 1.03 to 4.0, p = 0.04), but not Group 1. In conclusion, based on the definition used for CI-AKI, CI-AKI is observed in 6% to 15.7% of patients. An increase of 25% over baseline sCr does not identify high-risk patients. CI-AKI defined as an increase in sCr >0.3 mg/dl identifies 15.7% of the population at 2-fold higher risk of mortality.
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Prevention of Contrast and Radiation Injury During Coronary Angiography and Percutaneous Coronary Intervention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:32. [DOI: 10.1007/s11936-018-0621-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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114
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Sun L, Zhou X, Jiang J, Zang X, Chen X, Li H, Cao H, Wang Q. Growth differentiation factor-15 levels and the risk of contrast induced acute kidney injury in acute myocardial infarction patients treated invasively: A propensity-score match analysis. PLoS One 2018. [PMID: 29529072 PMCID: PMC5846798 DOI: 10.1371/journal.pone.0194152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Growth differentiation factor-15 (GDF-15) is an emerging biomarker for risk stratification in cardiovascular disease. Contrast-induced acute kidney injury (AKI) is an important complication in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). In this retrospectively observational study, we aimed to determine the role of GDF-15 and the risk of AKI in acute myocardial infarction (AMI) patients. METHODS The medical records of 1195 patients with AMI were reviewed. After exclusion criteria, a total of 751 eligible patients who underwent CAG or PCI were studied. Preoperative clinical parameters including GDF-15 levels were recorded. Multivariate logistic regression analysis was used to identify the risk factors of AKI. Subsequently, to reduce a potential selection bias and to balance differences between the two groups, a propensity score-matched analysis was performed. We recorded the 30-day all-cause mortality of the total study population. Kaplan-Meier analysis was performed to identify the association between short term survival in AMI patients and GDF-15 level. RESULTS Among 751 enrolled patients, 106 patients (14.1%) developed AKI. Patients were divided into two groups: AKI group (n = 106) and non-AKI group (n = 645). GDF-15 levels were significantly higher in AKI group compared to non-AKI group (1328.2 ± 349.7 ng/L vs. 1113.0 ± 371.3 ng/L, P <0.001). Multivariate logistic regression analyses showed GDF-15 was an independent risk factor of AKI (per 1000 ng/L increase of GDF-15, OR: 3.740, 95% CI: 1.940-7.207, P < 0.001). According to GDF-15 tertiles, patients were divided into three groups. Patients in middle (OR 2.93, 95% CI: 1.46-5.89, P = 0.003) and highest GDF-15 tertile (OR 3.72, 95% CI: 1.87-7.39, P <0.001) had higher risk of AKI compared to patients in the lowest GDF-15 tertile. The propensity score-matched group set comprised of 212 patients. Multivariate logistic regression revealed that GDF-15 is still an independent risk factor for AKI after matching (per 1000 ng/L increase of GDF-15, OR: 2.395, 95% CI: 1.020-5.626, P = 0.045). Based on the Kaplan-Meier analysis, the risk of 30-day all-cause mortality increased in higher GDF-15 tertiles log rank chi-square: 29.895, P <0.001). CONCLUSION This suggests that preoperative plasma GDF-15 is an independent risk factor of AKI in AMI patients underwent CAG or PCI. GDF-15 and AKI are associated with poor short term survival of AMI patients.
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Affiliation(s)
- Ling Sun
- Department of Cardiology, Changzhou No.2 people’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
| | - Xuejun Zhou
- Department of Cardiology, Changzhou No.2 people’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
| | - Jianguang Jiang
- Department of Cardiology, Changzhou No.2 people’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
| | - Xuan Zang
- Department of Cardiology, Changzhou No.2 people’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
| | - Xin Chen
- Department of Cardiology, Changzhou No.2 people’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
| | - Haiyan Li
- Department of Cardiology, Changzhou No.2 people’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
| | - Haitao Cao
- Department of Cardiology, Changzhou No.2 people’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
| | - Qingjie Wang
- Department of Cardiology, Changzhou No.2 people’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
- * E-mail:
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Giacoppo D, Gargiulo G, Buccheri S, Aruta P, Byrne RA, Cassese S, Dangas G, Kastrati A, Mehran R, Tamburino C, Capodanno D. Preventive Strategies for Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Procedures: Evidence From a Hierarchical Bayesian Network Meta-Analysis of 124 Trials and 28 240 Patients. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.004383. [PMID: 28487354 DOI: 10.1161/circinterventions.116.004383] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 03/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The effectiveness of currently available effective preventive strategies for contrast-induced acute kidney injury (CIAKI) is a matter of debate. METHODS AND RESULTS We performed a Bayesian random-effects network meta-analysis of 124 trials (28 240 patients) comparing a total of 10 strategies: saline, statin, N-acetylcysteine (NAC), sodium bicarbonate (NaHCO3), NAC+NaHCO3, ascorbic acid, xanthine, dopaminergic agent, peripheral ischemic preconditioning, and natriuretic peptide. Compared with saline, the risk of CIAKI was reduced by using statin (odds ratio [OR], 0.42; 95% credible interval [CrI], 0.26-0.67), xanthine (OR, 0.32; 95% CrI, 0.17-0.57), ischemic preconditioning (OR, 0.48; 95% CrI, 0.26-0.87), NAC+NaHCO3 (OR, 0.50; 95% CrI, 0.33-0.76), NAC (OR, 0.68; 95% CrI, 0.55-0.84), and NaHCO3 (OR, 0.66; 95% CrI, 0.47-0.90). The benefit of statin therapy was consistent across multiple sensitivity analyses, whereas the efficacy of all the other strategies was questioned by restricting the analysis to high-quality trials. Overall, high heterogeneity was observed for comparisons involving xanthine and ischemic preconditioning, although the impact of NAC and xanthine was probably influenced by publication bias/small-study effect. Hydration alone was the least effective preventive strategy for CIAKI. Meta-regressions did not reveal significant associations with baseline creatinine and contrast volume. In patients with diabetes mellitus, no strategy was found to reduce the incidence of CIAKI. CONCLUSIONS In patients undergoing percutaneous coronary procedures, statin administration is associated with a marked and consistent reduction in the risk of CIAKI compared with saline. Although xanthine, NAC, NaHCO3, NAC+NaHCO3, ischemic preconditioning, and natriuretic peptide may have nephroprotective effects, these results were not consistent across multiple sensitivity analyses.
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Affiliation(s)
- Daniele Giacoppo
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Giuseppe Gargiulo
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Sergio Buccheri
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Patrizia Aruta
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Robert A Byrne
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Salvatore Cassese
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - George Dangas
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Adnan Kastrati
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Roxana Mehran
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Corrado Tamburino
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.)
| | - Davide Capodanno
- From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.).
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The Incidence and the Prognostic Impact of Acute Kidney Injury in Acute Myocardial Infarction Patients: Current Preventive Strategies. Cardiovasc Drugs Ther 2018; 32:81-98. [DOI: 10.1007/s10557-017-6766-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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117
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Reinstadler SJ, Stiermaier T, Eitel C, Metzler B, de Waha S, Fuernau G, Desch S, Thiele H, Eitel I. Relationship between diabetes and ischaemic injury among patients with revascularized ST-elevation myocardial infarction. Diabetes Obes Metab 2017; 19:1706-1713. [PMID: 28474817 DOI: 10.1111/dom.13002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/14/2017] [Accepted: 05/03/2017] [Indexed: 12/01/2022]
Abstract
AIMS Studies comparing reperfusion efficacy and myocardial damage between diabetic and non-diabetic patients with ST-elevation myocardial infarction (STEMI) are scarce and have reported conflicting results. The aim was to investigate the impact of preadmission diabetic status on myocardial salvage and damage as determined by cardiac magnetic resonance (CMR), and to evaluate its prognostic relevance. MATERIALS AND METHODS We enrolled 792 patients with STEMI at 8 sites. CMR core laboratory analysis was performed to determine infarct characteristics. Major adverse cardiac events (MACE), defined as a composite of all-cause death, non-fatal re-infarction and new congestive heart failure, were recorded at 12 months. Patients were categorized according to preexisting diabetes mellitus (DM), and according to insulin-treated DM (ITDM) and non-insulin-treated DM (NITDM). RESULTS One-hundred and sixty (20%) patients had DM and 74 (9%) were insulin-treated. There was no difference in the myocardial salvage index, infarct size, microvascular obstruction and left ventricular ejection fraction between all patient groups (all P > .05). Patients with DM were at higher risk of MACE (11% vs 6%, P = .03) than non-DM patients. After stratification according to preadmission anti-diabetic therapy, MACE rate was comparable between NITDM and non-DM (P > .05), whereas the group of ITDM patients had significantly worse outcome (P < .001). CONCLUSIONS Diabetic patients with STEMI, especially those having ITDM, had an increased risk of MACE. The adverse clinical outcome was, however, not explained by an impact of DM on reperfusion success or myocardial damage. Clinical trial registry number: NCT00712101.
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Affiliation(s)
- Sebastian J Reinstadler
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Stiermaier
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Charlotte Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Suzanne de Waha
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Georg Fuernau
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Steffen Desch
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Holger Thiele
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
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The Assessment of the Risk of Acute Kidney Injury in Patients Undergoing an Urgent Endovascular Treatment Due to Severe Renal Bleeding. Cardiovasc Intervent Radiol 2017; 41:398-405. [DOI: 10.1007/s00270-017-1800-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/21/2017] [Indexed: 12/20/2022]
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119
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Gohbara M, Hayakawa A, Akazawa Y, Furihata S, Kondo A, Fukushima Y, Tomari S, Endo T, Kimura K, Tamura K. Association Between Acidosis Soon After Reperfusion and Contrast-Induced Nephropathy in Patients With a First-Time ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2017; 6:JAHA.117.006380. [PMID: 28835362 PMCID: PMC5586466 DOI: 10.1161/jaha.117.006380] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Contrast‐induced nephropathy (CIN) is associated with poor outcomes in patients with acute myocardial infarction. However, the predictors of CIN have yet to be fully elucidated. Methods and Results The study included 273 consecutive patients with a first‐time ST‐segment elevation myocardial infarction who underwent reperfusion within 12 hours of symptom onset. The exclusion criteria were hemodialysis, mechanical ventilation, or previous coronary artery bypass grafting. All patients underwent arterial blood gas analysis soon after reperfusion. CIN was defined as an increase of 0.5 mg/dL in serum creatinine or a 25% increase from baseline between 48 and 72 hours after contrast medium exposure. Acidosis was defined as an arterial blood pH <7.35. CIN was observed in 35 patients (12.8%). Multivariable logistic regression analysis with forward stepwise algorithm revealed a significant association between CIN and the following: reperfusion time, the prevalence of hypertension, peak creatine kinase‐MB, high‐sensitivity C‐reactive protein on admission, and the incidence of acidosis (P<0.05). Multivariable logistic regression analysis revealed that the incidence of acidosis was associated with CIN when adjusted for age, male sex, body mass index, amount of contrast medium used, estimated glomerular filtration rate on admission, glucose level on admission, high‐sensitivity C‐reactive protein on admission, and left ventricular ejection fraction (P<0.05). Moreover, the incidence of acidosis was associated with CIN when adjusted for the Mehran CIN risk score (odds ratio: 2.229, P=0.049). Conclusions The incidence of acidosis soon after reperfusion was associated with CIN in patients with a first‐time ST‐segment elevation myocardial infarction.
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Affiliation(s)
- Masaomi Gohbara
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Azusa Hayakawa
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Yusuke Akazawa
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Shuta Furihata
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Ai Kondo
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Yusuke Fukushima
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Sakie Tomari
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Tsutomu Endo
- Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Karamasis GV, Hampton-Till J, Al-Janabi F, Mohdnazri S, Parker M, Ioannou A, Jagathesan R, Kabir A, Sayer JW, Robinson NM, Aggarwal RK, Clesham GJ, Gamma RA, Kelly PA, Tang KH, Davies JR, Keeble T. Impact of point-of-care pre-procedure creatinine and eGFR testing in patients with ST segment elevation myocardial infarction undergoing primary PCI: The pilot STATCREAT study. Int J Cardiol 2017; 240:8-13. [DOI: 10.1016/j.ijcard.2017.03.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/23/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
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121
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Reinstadler SJ, Kronbichler A, Reindl M, Feistritzer HJ, Innerhofer V, Mayr A, Klug G, Tiefenthaler M, Mayer G, Metzler B. Acute kidney injury is associated with microvascular myocardial damage following myocardial infarction. Kidney Int 2017; 92:743-750. [PMID: 28412022 DOI: 10.1016/j.kint.2017.02.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/13/2017] [Accepted: 02/16/2017] [Indexed: 11/28/2022]
Abstract
Acute kidney injury (AKI) is a frequent complication in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention. However, the pathophysiology of AKI in this setting is complex and goes beyond the administration of contrast media. Studies assessing the impact of infarct characteristics on AKI are currently lacking. Therefore, we investigated the association of AKI with myocardial as well as microvascular injury in an initial total of 361 consecutive STEMI patients treated by primary percutaneous coronary intervention. Of these, 318 patients were included in final analysis. Serum creatinine was measured on admission as well as 24, 48, and 72 hours thereafter with AKI defined as an increase in serum creatinine of 0.3 mg/dl or more. Cardiac magnetic resonance (CMR) scans were performed in the first week after infarction, with microvascular injury visualized by late gadolinium enhancement CMR defined as any region of hypoenhancement within the hyperenhanced area of infarction. Sixteen patients developed AKI. They showed significantly lower left ventricular ejection fraction (45[interquartile range 40-52]% vs. 54[47-59]%), larger infarct size (21[15-35]% vs. 12[7-22]%) of left ventricular myocardial mass, and more frequent microvascular injury (81 vs. 46%) than those free of AKI. Meaningfully, in multivariate analysis including all CMR data, microvascular injury was the sole independent predictor of AKI (odds ratio 6.74, 95% confidence interval of 1.49-30.43). Thus, among revascularized STEMI patients, the presence of microvascular injury assessed by CMR was independently associated with an increased risk of AKI. This suggests a potential pathophysiological link between cardiac microvascular disease and renal injury following STEMI.
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Affiliation(s)
- Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Andreas Kronbichler
- University Clinic of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Hans-Josef Feistritzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Veronika Innerhofer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Martin Tiefenthaler
- University Clinic of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Gert Mayer
- University Clinic of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria.
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Mavrogeni S, Koutsogeorgopoulou L, Dimitroulas T, Markousis-Mavrogenis G, Kolovou G. Complementary role of cardiovascular imaging and laboratory indices in early detection of cardiovascular disease in systemic lupus erythematosus. Lupus 2017; 26:227-236. [DOI: 10.1177/0961203316671810] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background Cardiovascular disease (CVD) has been documented in >50% of systemic lupus erythematosus (SLE) patients, due to a complex interplay between traditional risk factors and SLE-related factors. Various processes, such as coronary artery disease, myocarditis, dilated cardiomyopathy, vasculitis, valvular heart disease, pulmonary hypertension and heart failure, account for CVD complications in SLE. Methods Electrocardiogram (ECG), echocardiography (echo), nuclear techniques, cardiac computed tomography (CT), cardiovascular magnetic resonance (CMR) and cardiac catheterization (CCa) can detect CVD in SLE at an early stage. ECG and echo are the cornerstones of CVD evaluation in SLE. The routine use of cardiac CT and nuclear techniques is limited by radiation exposure and use of iodinated contrast agents. Additionally, nuclear techniques are also limited by low spatial resolution that does not allow detection of sub-endocardial and sub-epicardial lesions. CCa gives definitive information about coronary artery anatomy and pulmonary artery pressure and offers the possibility of interventional therapy. However, it carries the risk of invasive instrumentation. Recently, CMR was proved of great value in the evaluation of cardiac function and the detection of myocardial inflammation, stress-rest perfusion defects and fibrosis. Results An algorithm for CVD evaluation in SLE includes clinical, laboratory, ECG and echo assessment as well as CMR evaluation in patients with inconclusive findings, persistent cardiac symptoms despite normal standard evaluation, new onset of life-threatening arrhythmia/heart failure and/or as a tool to select SLE patients for CCa. Conclusions A non-invasive approach including clinical, laboratory and imaging evaluation is key for early CVD detection in SLE.
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Affiliation(s)
- S Mavrogeni
- Onassis Cardiac Surgery Center, Athens, Greece
| | - L Koutsogeorgopoulou
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | - T Dimitroulas
- 4th Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - G Kolovou
- Onassis Cardiac Surgery Center, Athens, Greece
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Kuji S, Kosuge M, Kimura K, Nakao K, Ozaki Y, Ako J, Noguchi T, Yasuda S, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Nishimura K, Miyamoto Y, Ishihara M. Impact of Acute Kidney Injury on In-Hospital Outcomes of Patients With Acute Myocardial Infarction - Results From the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) Substudy. Circ J 2017; 81:733-739. [PMID: 28179593 DOI: 10.1253/circj.cj-16-1094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with poor outcome after acute myocardial infarction (AMI), but whether hemodynamic status at presentation influences this prognostic significance is unknown.Methods and Results:A total of 2,798 AMI patients admitted within 48 h after symptom onset and who underwent urgent coronary angiography were enrolled in the present study. AKI was defined as an increase in serum creatinine ≥0.3 mg/dL or ≥50% within 48 h during hospitalization. Patients were classified into 3 groups according to Killip class on admission: Killip 1, n=2,164; Killip 2-3, n=366; and Killip 4, n=268. AKI occurred more frequently with increasing Killip class (Killip 1, 2-3, and 4: 6.3%, 15.3%, and 31.3%, respectively; P<0.001). AKI was associated with increased in-hospital mortality, regardless of Killip class (non-AKI and AKI patients: 1.1% vs. 6.6% in Killip 1; 5.2% vs. 35.7% in Killip 2-3, and 28.8% vs. 45.2% in Killip 4, P<0.01 for all). On multivariate analysis, the adjusted OR of AKI for in-hospital mortality in Killip 1, Killip 2-3, and Killip 4 were 3.79 (95% CI: 1.54-9.33, P=0.004), 5.35 (95% CI: 2.67-10.7, P<0.001), and 1.48 (95% CI: 0.94-2.35, P=0.093), respectively. CONCLUSIONS In AMI patients undergoing urgent coronary angiography, AKI was significantly associated with increased in-hospital mortality in Killip 1 as well as Killip 2-3 at presentation, but not in Killip 4.
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Affiliation(s)
- Shotaro Kuji
- Division of Cardiology, Yokohama City University Medical Center
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Hospital
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Kazuteru Fujimoto
- Department of Cardiology, National Hospital Organization Kumamoto Medical Center
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University
| | - Atsushi Hirohata
- Department of Cardiology, The Sakakibara Heart Institute of Okayama
| | | | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University
| | - Kunihiro Nishimura
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
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Zhang WF, Zhang T, Ding D, Sun SQ, Wang XL, Chu SC, Shen LH, He B. Use of Both Serum Cystatin C and Creatinine as Diagnostic Criteria for Contrast-Induced Acute Kidney Injury and Its Clinical Implications. J Am Heart Assoc 2017; 6:JAHA.116.004747. [PMID: 28087509 PMCID: PMC5523641 DOI: 10.1161/jaha.116.004747] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Contrast-induced acute kidney injury (CI-AKI) was traditionally defined as an increase in serum creatinine (sCr) after contrast media exposure. Recently, serum cystatin C (sCyC) has been proposed as an alternative to detect acute changes in renal function. The clinical implications of combining sCyC and sCr to diagnose CI-AKI remain unknown. METHODS AND RESULTS One thousand seventy-one consecutive patients undergoing coronary angiography/intervention were prospectively enrolled. SCyC and sCr were assessed at baseline and 24 to 48 hours after contrast media exposure. CI-AKI determined by sCr (CI-AKIsCr) was defined as an sCr increase greater than 0.3 mg/dL or 50% from baseline. Major adverse events at 12 months were assessed. CI-AKIsCr developed in 25 patients (2.3%). Twelve-month follow-up was available for 1063 patients; major adverse events occurred in 61 patients (5.7%). By receiver operating characteristic curve analysis, an sCyC increase of greater than 15% was the optimal cutoff for CI-AKIsCr detection, which occurred in 187 patients (17.4%). To evaluate the use of both sCyC and sCr as CI-AKI diagnostic criteria, we stratified patients into 3 groups: no CI-AKI, CI-AKI detected by a single marker, and CI-AKI detected by both markers. Multivariable logistic regression revealed that the predictability of major adverse events increased in a stepwise fashion in the 3 groups (no-CI-AKI group as the reference, CI-AKI detected by a single marker: odds ratio=2.25, 95% CI: 1.24-4.10, P<0.01; CI-AKI detected by both markers: odds ratio=10.00, 95% CI: 3.13-31.91, P<0.001). CONCLUSIONS Combining sCyC and sCr to diagnose CI-AKI would be beneficial for risk stratification and prognosis in patients after contrast media exposure.
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Affiliation(s)
- Wei-Feng Zhang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tuo Zhang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ding Ding
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD
| | - Shi-Qun Sun
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao-Lei Wang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shi-Chun Chu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ling-Hong Shen
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ben He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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125
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Intravascular ultrasound-guided drug-eluting stent implantation. Cardiovasc Interv Ther 2016; 32:1-11. [DOI: 10.1007/s12928-016-0438-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
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126
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Liu YH, Wang SQ, Xue JH, Liu Y, Chen JY, Li GF, He PC, Tan N. Hundred top-cited articles focusing on acute kidney injury: a bibliometric analysis. BMJ Open 2016; 6:e011630. [PMID: 27466238 PMCID: PMC4964173 DOI: 10.1136/bmjopen-2016-011630] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a major global health issue, associated with poor short-term and long-term outcomes. Research on AKI is increasing with numerous articles published. However, the quantity and quality of research production in the field of AKI is unclear. METHODS AND ANALYSIS To analyse the characteristics of the most cited articles on AKI and to provide information about achievements and developments in AKI, we searched the Science Citation Index Expanded for citations of AKI articles. For the top 100 most frequently cited articles (T100), we evaluated the number of citations, publication time, province of origin, journal, impact factor, topic or subspecialty of the research, and publication type. RESULTS The T100 articles ranged from a maximum of 1971 citations to a minimum of 215 citations (median 302 citations). T100 articles were published from 1951 to 2011, with most articles published in the 2000s (n=77), especially the 5-year period from 2002 to 2006 (n=51). The publications appeared in 30 journals, predominantly in the general medical journals, led by New England Journal of Medicine (n=17), followed by expert medical journals, led by the Journal of the American Society of Nephrology (n=16) and Kidney International (n=16). The majority (83.7%) of T100 articles were published by teams involving ≥3 authors. T100 articles originated from 15 countries, led by the USA (n=81) followed by Italy (n=9). Among the T100 articles, 69 were clinical research, 25 were basic science, 21 were reviews, 5 were meta-analyses and 3 were clinical guidelines. Most clinical articles (55%) included patients with any cause of AKI, followed by the specific causes of contrast-induced AKI (25%) and cardiac surgery-induced AKI (15%). CONCLUSIONS This study provides a historical perspective on the scientific progress on AKI, and highlights areas of research requiring further investigations and developments.
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Affiliation(s)
- Yuan-hui Liu
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Sheng-qi Wang
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, 1038Guangzhou, China
| | - Jin-hua Xue
- Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Physiology, School of Basic Medical Sciences, Gannan Medical University, Ganzhou, China
| | - Yong Liu
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ji-yan Chen
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guo-feng Li
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, 1038Guangzhou, China
| | - Peng-cheng He
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ning Tan
- Department of Mammary Disease, Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
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Güngör B, Karataş MB, İpek G, Özcan KS, Çanga Y, Onuk T, Keskin M, Hayıroğlu Mİ, Karadeniz FÖ, Sungur A, Öztürk R, Bolca O. Association of contrast-induced nephropathy with bare metal stent restenosis in STEMI patients treated with primary PCI. Ren Fail 2016; 38:1167-73. [PMID: 27436614 DOI: 10.1080/0886022x.2016.1209024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Contrast induced nephropathy (CIN) has been proven as a clinical condition related to adverse cardiovascular outcomes. However, relationship between CIN and stent restenosis (SR) remains unclear. In this study, we aimed to investigate the association of CIN with SR rates after primary percutaneous coronary intervention (PCI) and bare metal stent (BMS) implantation. METHODS A total number of 3225 patients who had undergone primary PCI for STEMI were retrospectively recruited. The medical reports of subjects were searched to find whether the patients had a control coronary angiogram (CAG) and 587 patients with control CAG were included in the study. The laboratory parameters of 587 patients were recorded and patients who developed CIN after primary PCI were defined. Contrast induced nephropathy was defined as either a 25% increase in serum creatinine from baseline or 0.5 mg/dL increase in absolute value, within 72 h of intravenous contrast administration. RESULTS The duration between primary PCI and control CAG was median 12 months [8-24 months]. The rate of SR was significantly higher in CIN (+) group compared to CIN (-) group (64% vs. 46%, p < 0.01). In multivariate Cox regression analysis, male gender, stent length, admission WBC levels and presence of CIN (HR 1.39, 95% CI 1.06-1.82, p < 0.01) remained as the independent predictors of SR in the study population. CONCLUSION Gender, stent length, higher serum WBC levels and presence of CIN are independently correlated with SR in STEMI patients treated with BMS implantation.
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Affiliation(s)
- Barış Güngör
- a Department of Cardiology , Siyami Ersek Cardiovascular and Thoracic Surgery Center , Istanbul , Turkey
| | - Mehmet Baran Karataş
- a Department of Cardiology , Siyami Ersek Cardiovascular and Thoracic Surgery Center , Istanbul , Turkey
| | - Göktürk İpek
- a Department of Cardiology , Siyami Ersek Cardiovascular and Thoracic Surgery Center , Istanbul , Turkey
| | - Kazım Serhan Özcan
- b Department of Cardiology , Derince Training and Research Hospital , Kocaeli , Turkey
| | - Yiğit Çanga
- a Department of Cardiology , Siyami Ersek Cardiovascular and Thoracic Surgery Center , Istanbul , Turkey
| | - Tolga Onuk
- a Department of Cardiology , Siyami Ersek Cardiovascular and Thoracic Surgery Center , Istanbul , Turkey
| | - Muhammed Keskin
- a Department of Cardiology , Siyami Ersek Cardiovascular and Thoracic Surgery Center , Istanbul , Turkey
| | - Mert İlker Hayıroğlu
- a Department of Cardiology , Siyami Ersek Cardiovascular and Thoracic Surgery Center , Istanbul , Turkey
| | | | - Aylin Sungur
- d Department of Cardiology , Kahramanmaraş Necip Fazıl State Hospital , Kahramanmaraş , Turkey
| | - Recep Öztürk
- a Department of Cardiology , Siyami Ersek Cardiovascular and Thoracic Surgery Center , Istanbul , Turkey
| | - Osman Bolca
- a Department of Cardiology , Siyami Ersek Cardiovascular and Thoracic Surgery Center , Istanbul , Turkey
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128
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Prognostic Impact of Combined Contrast-Induced Acute Kidney Injury and Hypoxic Liver Injury in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Results from INTERSTELLAR Registry. PLoS One 2016; 11:e0159416. [PMID: 27415006 PMCID: PMC4945029 DOI: 10.1371/journal.pone.0159416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/01/2016] [Indexed: 11/19/2022] Open
Abstract
Background Besides contrast-induced acute kidney injury(CI-AKI), adscititious vital organ damage such as hypoxic liver injury(HLI) may affect the survival in patients with ST-elevation myocardial infarction (STEMI). We sought to evaluate the prognostic impact of CI-AKI and HLI in STEMI patients who underwent primary percutaneous coronary intervention (PCI). Methods A total of 668 consecutive patients (77.2% male, mean age 61.3±13.3 years) from the INTERSTELLAR STEMI registry who underwent primary PCI were analyzed. CI-AKI was defined as an increase of ≥0.5 mg/dL in serum creatinine level or 25% relative increase, within 48h after the index procedure. HLI was defined as ≥2-fold increase in serum aspartate transaminase above the upper normal limit on admission. Patients were divided into four groups according to their CI-AKI and HLI states. Major adverse cardiovascular and cerebrovascular events (MACCE) defined as a composite of all-cause mortality, non-fatal MI, non-fatal stroke, ischemia-driven target lesion revascularization and target vessel revascularization were recorded. Results Over a mean follow-up period of 2.2±1.6 years, 94 MACCEs occurred with an event rate of 14.1%. The rates of MACCE and all-cause mortality were 9.7% and 5.2%, respectively, in the no organ damage group; 21.3% and 21.3% in CI-AKI group; 18.5% and 14.6% in HLI group; and 57.7% and 50.0% in combined CI-AKI and HLI group. Survival probability plots of composite MACCE and all-cause mortality revealed that the combined CI-AKI and HLI group was associated with the worst prognosis (p<0.0001 for both). Conclusion Combined CI-AKI after index procedure and HLI on admission is associated with poor clinical outcomes in patients with STEMI who underwent primary PCI. (INTERSTELLAR ClinicalTrials.gov number, NCT02800421.)
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129
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Odutayo A, Wong CX, Farkouh M, Altman DG, Hopewell S, Emdin CA, Hunn BH. AKI and Long-Term Risk for Cardiovascular Events and Mortality. J Am Soc Nephrol 2016; 28:377-387. [PMID: 27297949 DOI: 10.1681/asn.2016010105] [Citation(s) in RCA: 237] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/21/2016] [Indexed: 12/11/2022] Open
Abstract
AKI associates with increased long-term risk of mortality, but the prognostic significance of AKI in terms of long-term cardiovascular disease remains unconfirmed. We conducted a systematic review and meta-analysis to assess whether AKI associates with long-term cardiovascular disease. We included cohort studies that examined adults with and without AKI and reported a multivariable-adjusted relative risk (RR) for the association between AKI and cardiovascular mortality, major cardiovascular events, and disease-specific events: congestive heart failure, acute myocardial infarction, and stroke. Twenty-five studies involving 254,408 adults (55,150 with AKI) were included. AKI associated with an 86% and a 38% increased risk of cardiovascular mortality and major cardiovascular events, respectively ([RR 1.86; 95% confidence interval (95% CI), 1.72 to 2.01] and [RR 1.38; 95% CI, 1.23 to 1.55], respectively). For disease-specific events, AKI associated with a 58% increased risk of heart failure (RR 1.58; 95% CI, 1.46 to 1.72) and a 40% increased risk of acute myocardial infarction (RR 1.40; 95% CI, 1.23 to 1.59). The elevated risk of heart failure and acute myocardial infarction persisted in subgroup analyses on the basis of AKI severity and the proportion of adults with baseline ischemic heart disease. Finally, AKI was associated with a 15% increased risk of stroke (RR 1.15; 95% CI, 1.03 to 1.28). In conclusion, AKI associates with an elevated risk of cardiovascular mortality and major cardiovascular events, particularly heart failure and acute myocardial infarction.
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Affiliation(s)
- Ayodele Odutayo
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; .,Centre for Statistics in Medicine
| | | | - Michael Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada; and
| | | | | | | | - Benjamin H Hunn
- School of Medicine, University of Tasmania, Hobart, Australia.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
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130
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Ali ZA, Karimi Galougahi K, Nazif T, Maehara A, Hardy MA, Cohen DJ, Ratner LE, Collins MB, Moses JW, Kirtane AJ, Stone GW, Karmpaliotis D, Leon MB. Imaging- and physiology-guided percutaneous coronary intervention without contrast administration in advanced renal failure: a feasibility, safety, and outcome study. Eur Heart J 2016; 37:3090-3095. [PMID: 26957421 DOI: 10.1093/eurheartj/ehw078] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/03/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS The feasibility, safety, and clinical utility of percutaneous coronary intervention (PCI) without radio-contrast medium in patients with advanced chronic kidney disease (CKD) are unknown. In this series, we investigated a specific strategy for 'zero contrast' PCI with the aims of preserving renal function and preventing the need for renal replacement therapy (RRT) in patients with advanced CKD. METHODS AND RESULTS A total of 31 patients with advanced CKD [creatinine = 4.2 mg/dL, inter-quartile range (IQR) 3.1-4.8, estimated glomerular filtration rate = 16 ± 8 mL/min/1.73 m2] who had clinical indication for PCI based on a prior minimal contrast coronary angiogram were included. Zero contrast PCI was performed at least 1 week after diagnostic angiography using real-time intravascular ultrasound (IVUS) guidance, with pre- and post-PCI measurements of fractional flow reserve and coronary flow reserve to confirm physiological improvement. This approach resulted in successful PCI, no major adverse cardiovascular events and preservation of renal function without the need for RRT within a follow-up time of 79 days (IQR 33-207) in all patients. CONCLUSION In patients with advanced CKD who require revascularization, PCI may safely be performed without contrast using IVUS and physiological guidance with high procedural success and without complications.
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Affiliation(s)
- Ziad A Ali
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA .,Cardiovascular Research Foundation, New York, NY, USA
| | - Keyvan Karimi Galougahi
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA
| | - Tamim Nazif
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Akiko Maehara
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Mark A Hardy
- Department of Surgery, New York Presbyterian Hospital and Columbia University, New York, NY, USA
| | - David J Cohen
- Division of Nephrology, New York Presbyterian Hospital and Columbia University, New York, NY, USA
| | - Lloyd E Ratner
- Department of Surgery, New York Presbyterian Hospital and Columbia University, New York, NY, USA
| | - Michael B Collins
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Jeffrey W Moses
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Ajay J Kirtane
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Dimitri Karmpaliotis
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Martin B Leon
- Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
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131
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Acute kidney injury among ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention: a multifactorial entity. J Nephrol 2016; 29:169-174. [PMID: 26861658 DOI: 10.1007/s40620-015-0255-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/27/2015] [Indexed: 12/16/2022]
Abstract
Acute kidney injury is a frequent complication among ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), and is associated with adverse outcomes. While contrast nephropathy is considered the most important reason for worsening of renal function, recent data have suggested the role of other important factors among this specific patient population. In the present review, we examine the various factors leading to renal impairment in STEMI patients and place the findings in the context of this specific patient population in the era of primary PCI. These factors include contrast nephropathy, time to coronary reperfusion, cardiac pump function and hemodynamics as well as various inflammatory and metabolic markers.
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132
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Abstract
Contrast-induced acute kidney injury (CI-AKI) is characterised by a rapid deterioration of renal function within a few days of parenteral administration of contrast media (CM) in the absence of alternative causes. CI-AKI is the most common form of iatrogenic kidney dysfunction with an estimated prevalence of 12 % in patients undergoing percutaneous coronary intervention. Although usually self-resolving, in patients with pre-existing chronic kidney disease (CKD) or concomitant risk factors for renal damage, CI-AKI is associated with increased short-and long-term morbidity and mortality. Therefore, risk stratification based on clinical and peri-procedural characteristics is crucial in selecting patients at risk of CI-AKI who would benefit the most from implementation of preventive measures.
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Affiliation(s)
- Michela Faggioni
- Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.,Cardiac Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Roxana Mehran
- Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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133
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Affiliation(s)
- Harold L Dauerman
- From the Department of Medicine, University of Vermont College of Medicine, Burlington
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