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López-Mínguez JR, Martín de Francisco AL, Soler MJ, Hernández F, Moreno R, Pinar E, Sampedro A, Mareque M, Oyagüez I. Cost-effectiveness analysis of dyevert™ Power XT in patients with chronic kidney disease undergoing percutaneous coronary intervention procedures in Spain. Catheter Cardiovasc Interv 2023. [PMID: 37300893 DOI: 10.1002/ccd.30744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the efficiency of Dyevert™ Power XT compared to the standard clinical practice when used for percutaneous coronary interventions (PCI). METHODS A Markov model was developed to estimate, over 3-month cycles and a lifetime time horizon, the cumulative costs and health outcomes (life years gained [LYG] and quality-adjusted life years [QALY]) in a hypothetical cohort of 1,000 patients with chronic kidney disease (CKD) 3b-4 and an average age of 72 years. The incidence of contrast-induced acute kidney injury for these patients is 18.89% in routine practice and 7.78% with Dyevert. QALYs were estimated by applying utilities by health state. Transitions between states and utilities were obtained from the literature. Overall all-cause and state-specific mortality were considered. The total cost (€2,022) estimated with the National Health System perspective included cost of the procedure and of CKD management. The parameters were validated by a panel of experts. A discount rate (3% per year) was applied to costs and outcomes. RESULTS The use of Dyevert yielded more health benefits (34.60 LYG and 5.69 QALYs) compared to the current standard practice (33.11 LYG and 5.38 QALYs). Lifetime cost accumulated at the end of the simulation resulted €30,211/patient with Dyevert and €33,895/patient with current standard clinical practice. CONCLUSIONS The use of Dyevert™ Power XT resulted dominant option, due to its higher effectiveness and lower cost as compared to standard clinical practice and, therefore, a preferred option in patients with CKD stages 3b-4 undergoing PCI in Spain.
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Affiliation(s)
- Jose R López-Mínguez
- Sección de Hemodinámica y Cardiología Intervencionista, Hospital Universitario de Badajoz, Badajoz, España
| | | | - M J Soler
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Felipe Hernández
- Unidad de Hemodinámica y Cardiología Intervencionista, Clínica Universidad de Navarra, Madrid, España
| | - Raul Moreno
- Unidad de Cardiología Intervencionista, Hospital Universitario La Paz, Madrid, España
| | - Eduardo Pinar
- Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - M Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| | - I Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
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Tarantini G, Prasad A, Rathore S, Bansal S, Gottfried R, Rosenkranz AR, Briguori C, Yaghoubi M, Mashayekhi A, Javanbakht M, Moloney E. DyeVert Contrast Reduction System Use in Patients Undergoing Coronary and/or Peripheral Angiography: A Systematic Literature Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:841876. [PMID: 35547222 PMCID: PMC9081570 DOI: 10.3389/fmed.2022.841876] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Contrast-associated acute kidney injury (CA-AKI) is an important adverse effect associated with injecting iodinated intra-arterial contrast media (CM) during coronary angiography. The DyeVert™ Contrast Reduction System is a medical device intended to reduce the intra-arterial CM volume (CMV) administered. The aim of this study was to assess DyeVert System clinical effectiveness and safety by implementing a systematic review and meta-analysis of existing evidence. Methods Systematic electronic literature searches were conducted in MEDLINE, Embase, the Cochrane Database of Systematic Reviews, ClinicalTrials.gov, and the International Clinical Trials Registry Platform database. Relevant data were extracted from included studies and meta-analyses were performed to synthesize evidence across studies. Results The review included 17 eligible studies involving 1,731 DyeVert System cases and 1,387 control cases (without the use of DyeVert). Meta-analyses demonstrated use of the DyeVert System reduced CMV delivered to the patient by 39.27% (95% CI, 36.10-42.48%, P < 0.001), reduced CMV/baseline renal function ratios (Hedges's g, -0.56; 95% CI, -0.70 to -0.42, P < 0.001) and percentage of cases exceeding the maximum CMV threshold (risk difference -0.31, 95% CI, -0.48 to -0.13, P < 0.001) while maintaining adequate image quality in 98% of cases. DyeVert System cases demonstrated lower CA-AKI incidence vs. controls (absolute risk reduction 5.00% (95% CI, 0.40-9.80%; P = 0.03), relative risk 0.60 (95% CI, 0.40-0.90; P = 0.01) with a pooled estimate of the number needed to treat with the DyeVert System to avoid 1 CA-AKI event of 20. Conclusion DyeVert System use significantly reduces CMV delivered to the patient, CMV/baseline renal function ratios, and CA-AKI incidence while maintaining image quality. Accordingly, the device may serve as an adjunctive, procedure-based strategy to prevent CA-AKI. Future multi-center studies are needed to further assess effects of minimizing CMV on endpoints such as CA-AKI prevention, incidence of adverse cardiac and renal events, and health care costs.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Anand Prasad
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio, TX, United States
| | - Sudhir Rathore
- Frimley Health National Health Service (NHS) Foundation Trust, Camberley, United Kingdom
| | - Shweta Bansal
- Department of Medicine, Division of Nephrology, University of Texas Health Science Center, San Antonio, TX, United States
| | - Regine Gottfried
- Clinic for General and Interventional Cardiology and Angiology, Herz- und Diabeteszentrum Nordrhein-Westfalen (NRW), Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Alexander R. Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Mohsen Yaghoubi
- Mercer University College of Pharmacy, Atlanta, GA, United States
| | - Atefeh Mashayekhi
- Optimax Access Ltd., Market Access Consultancy, University of Southampton Science Park, Hampshire, United Kingdom
| | - Mehdi Javanbakht
- Optimax Access Ltd., Market Access Consultancy, University of Southampton Science Park, Hampshire, United Kingdom
- Device Access UK Ltd., Market Access Consultancy, University of Southampton Science Park, Hampshire, United Kingdom
| | - Eoin Moloney
- Optimax Access Ltd., Market Access Consultancy, University of Southampton Science Park, Hampshire, United Kingdom
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O'Sullivan KJ, Kermavnar T, Gorski KA, Arnous S, O'Sullivan LW. Warmed contrast media temperature loss in traditional manifold systems during angiographic procedures. Acta Radiol 2021; 63:1627-1633. [PMID: 34747192 DOI: 10.1177/02841851211055393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Extrinsic warming of contrast media (CM) to 37 °C before angiographic procedures is performed to improve bolus kinetics and avoid potential adverse effects. Extrinsically warmed CM readily loses temperature after removal from the warming cabinet, but the extent of its cooling has not been previously investigated. PURPOSE To assess temperature loss of extrinsically warmed CM in tubing of traditional angiographic manifolds during simulated angiography. MATERIAL AND METHODS In total, 35 scheduled diagnostic angiographic procedures were observed in a hospital setting. Relevant time points of CM use during the procedures were recorded. The shortest, median, and longest procedures were then simulated in the experimental laboratory to measure CM temperatures at specific times at three locations along the tubing system. RESULTS The angiographic procedures lasted 7.0-26.6 min (median = 11.7 min), with the total duration dependent primarily on the time from contrast being removed from the warming cabinet to the commencement of imaging. During the simulated procedures, consistent patterns of temperature loss were observed. By the last simulated angiographic run, injected CM temperature decreased by 7.4-16.4 °C, depending on procedure length. Most of the heat loss occurred in the tubing between the CM bottle and coronary control syringe. CONCLUSION During angiographic procedures, prewarmed CM loses its temperature rapidly with the duration of exposure to ambient room temperature. If no additional measures are employed to maintain its temperature outside of the warming cabinet, extrinsic warming has limited impact on injected CM temperature.
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Affiliation(s)
- Kevin J. O'Sullivan
- School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
- Health Research Institute, School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
| | - Tjaša Kermavnar
- School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
| | | | | | - Leonard W. O'Sullivan
- School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
- Health Research Institute, School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
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Zimin VN, Jones MR, Richmond IV T, Durieux JC, Alaiti AM, Pereira GTR, Vergara-Martel A, Pizzato PE, Zago EI, Dallan LA, Bezerra HG. A Feasibility Study of the DyeVert™ Plus Contrast Reduction System to Reduce Contrast Media Volumes in Percutaneous Coronary Procedures Using Optical Coherence Tomography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 30:40-46. [DOI: 10.1016/j.carrev.2020.09.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/10/2020] [Accepted: 09/29/2020] [Indexed: 12/18/2022]
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Naidu SS, Abbott JD, Bagai J, Blankenship J, Garcia S, Iqbal SN, Kaul P, Khuddus MA, Kirkwood L, Manoukian SV, Patel MR, Skelding K, Slotwiner D, Swaminathan RV, Welt FG, Kolansky DM. SCAI expert consensus update on best practices in the cardiac catheterization laboratory: This statement was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS) in April 2021. Catheter Cardiovasc Interv 2021; 98:255-276. [PMID: 33909349 DOI: 10.1002/ccd.29744] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022]
Abstract
The current document commissioned by the Society for Cardiovascular Angiography and Interventions (SCAI) and endorsed by the American College of Cardiology, the American Heart Association, and Heart Rhythm Society represents a comprehensive update to the 2012 and 2016 consensus documents on patient-centered best practices in the cardiac catheterization laboratory. Comprising updates to staffing and credentialing, as well as evidence-based updates to the pre-, intra-, and post-procedural logistics, clinical standards and patient flow, the document also includes an expanded section on CCL governance, administration, and approach to quality metrics. This update also acknowledges the collaboration with various specialties, including discussion of the heart team approach to management, and working with electrophysiology colleagues in particular. It is hoped that this document will be utilized by hospitals, health systems, as well as regulatory bodies involved in assuring and maintaining quality, safety, efficiency, and cost-effectiveness of patient throughput in this high volume area.
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Affiliation(s)
- Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - J Dawn Abbott
- Cardiovascular Institute of Lifespan, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jayant Bagai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Blankenship
- Cardiology Division, The University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Sohah N Iqbal
- Mass General Brigham Salem Hospital, Salem, Massachusetts, USA
| | | | - Matheen A Khuddus
- The Cardiac and Vascular Institute and North Florida Regional Medical Center, Gainesville, Florida, USA
| | - Lorrena Kirkwood
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | | | - Manesh R Patel
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - David Slotwiner
- Division of Cardiology, New York Presbyterian, Weill Cornell Medicine Population Health Sciences, Queens, New York, USA
| | - Rajesh V Swaminathan
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Frederick G Welt
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Daniel M Kolansky
- Division of Cardiovascular Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Koowattanatianchai S, Chantadansuwan T, Kaladee A, Phinyo P, Patumanond J. Practical Risk Stratification Score for Prediction of Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction. Cardiol Res 2019; 10:350-357. [PMID: 31803333 PMCID: PMC6879045 DOI: 10.14740/cr939] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 09/12/2019] [Indexed: 11/11/2022] Open
Abstract
Background Contrast-induced nephropathy (CIN) is a common complication of percutaneous coronary intervention (PCI). This study aimed to develop a new risk stratification score that is simpler and more practical than the standard Mehran risk score (MRS) in prediction of CIN after primary PCI in ST-segment elevation myocardial infarction (STEMI) patients. Methods A prognostic prediction research with clinical risk score development was conducted. All STEMI patients who underwent primary PCI at the Central Chest Institute from June 1, 2017 to June 30, 2018 were included. Multivariable logistic regression analysis was used to identify independent predictors of CIN with a significant P value < 0.05. Logistic coefficients of each predictor were used for score weighting and transformation. Predictive performance was validated and compared between newly-derived risk score and the MRS by non-parametric receiver operating characteristic (ROC) regression. Results A total of 217 patients, 43 (19.8%) with CIN and 174 (80.2%) without CIN, were included for score derivation. A total of 13 potential predictors were explored under multivariable logistic regression model and were subsequently eliminated. The new risk score was based on three final predictors which were ejection fraction of less than 40%, triple-vessel disease as findings from angiogram, and the use of intra-aortic balloon pump (IABP). With only three predictor variables, the score predicted the risk of CIN with good discriminative ability (area under the receiver operating characteristic curve (AuROC): 0.83, 95% confidence interval (CI): 0.76 - 0.90) which was higher than that of the MRS (AuROC: 0.78, 95% CI: 0.69 - 0.87). The score was categorized into low-risk (positive predictive value (PPV): 9.9, 95% CI: 5.4 - 14.4) and high-risk (PPV: 56.5, 95% CI: 42.4 - 70.8) groups at the cut-off point of 2. Conclusions The newly developed score was proved to have good predictive performance with fewer numbers of predictors and could be practically applied for risk stratification of CIN in STEMI patients who required emergent primary PCI.
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Affiliation(s)
- Sukrisd Koowattanatianchai
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Burapha University, Chonburi, Thailand
| | | | - Akaphol Kaladee
- School of Health Science, Sukhothai Thammathirat Open University, Nonthaburi, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Pucciarelli A, Arcari A, Popusoi G, Cioppa A, Salemme L, Iacovelli F, Napolitano G, Esposito G, Tesorio T, Stabile E. Incidence and predictors of acute kidney injury in patients undergoing proximal protected carotid artery stenting. EUROINTERVENTION 2018; 14:e360-e366. [PMID: 29633937 DOI: 10.4244/eij-d-17-00308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Many studies have analysed the occurrence of acute kidney injury (AKI) after percutaneous coronary intervention (PCI) but there are limited data relating to AKI risk in patients undergoing carotid artery stenting (CAS). The aim of this study was to determine the incidence and predictors of AKI in patients undergoing proximal protected CAS. METHODS AND RESULTS We analysed 456 patients undergoing proximal protected CAS. A binomial multivariate logistic model was developed including patients' clinical and angiographic/procedural characteristics. AKI (defined as an sCr increase ≥0.3 mg/dl or ≥1.5-fold sCr increase from baseline or more than 50% increase from baseline, within 48 hours post procedure) occurred in 155 patients (34%). AKI patients were more frequently affected by hypertension, diabetes, dyslipidaemia and anaemia, and presented lower renal function at baseline. Higher contrast volume to creatinine clearance ratio (2.40±1.44 vs. 2.08±1.15; p=0.01), lower post-procedural mean arterial pressure (MAP) (94.3±17.7 vs. 99.6±18.5 mmHg; p=0.003) and a more frequent post-procedural systolic pressure drop (∆SBP >50 mmHg) (23.9% vs. 14.3%, p=0.01) were observed in the AKI group of patients. At multivariate analysis, independent predictors of AKI were ∆SBP >50 mmHg, diabetes mellitus and dyslipidaemia. CONCLUSIONS AKI can occur quite frequently after proximal protected CAS and is related to clinical and procedural features. These data should be confirmed in larger registries or randomised trials.
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Liu LY, Liu Y, Wu MY, Sun YY, Ma FZ. Efficacy of atorvastatin on the prevention of contrast-induced acute kidney injury: a meta-analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2018. [PMID: 29535505 PMCID: PMC5840281 DOI: 10.2147/dddt.s149106] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Results of studies on the efficacy of atorvastatin pretreatment on reducing the prevalence of contrast-induced acute kidney injury (CIAKI) in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) have been controversial. Objective We undertook a meta-analysis to evaluate the efficacy of atorvastatin on contrast-induced nephropathy (CIN) after CAG or PCI. Materials and methods We undertook a systematic search of electronic databases (PubMed, Embase, and the Cochrane Library) up to June 2017. A meta-analysis was carried out including randomized controlled trials (RCTs) that compared atorvastatin pretreatment with pretreatment with a low-dose statin or placebo for CIAKI prevention in patients undergoing CAG. The main endpoint was CIN prevalence. Results Nine RCTs were included in our meta-analysis. Atorvastatin pretreatment reduced the prevalence of CIN significantly (odds ratio [OR] 0.46; 95% confidence interval [95% CI] 0.27–0.79; p=0.004). The benefit of high-dose atorvastatin pretreatment was consistent when compared with the control group (OR 0.45; 95% CI 0.21–0.95; p=0.04). Conclusion At high doses, atorvastatin pretreatment was associated with a significant reduction in the prevalence of CIAKI in patients undergoing CAG. Pretreatment with high-dose atorvastatin could be employed to prevent CIAKI.
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Affiliation(s)
| | - Yang Liu
- Department of Nephrology, the First Hospital of Jilin University
| | - Mei-Yan Wu
- Department of Nephrology, the First Hospital of Jilin University
| | - Yan-Yan Sun
- Department of Nephrology, the Fourth Hospital of Jilin University, Changchun, China
| | - Fu-Zhe Ma
- Department of Nephrology, the First Hospital of Jilin University
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Shah R, Wood SJ, Khan SA, Chaudhry A, Rehan Khan M, Morsy MS. High-volume forced diuresis with matched hydration using the RenalGuard System to prevent contrast-induced nephropathy: A meta-analysis of randomized trials. Clin Cardiol 2017; 40:1242-1246. [PMID: 29247527 DOI: 10.1002/clc.22817] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/11/2017] [Accepted: 09/16/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a well-recognized complication of coronary angiography that is associated with poor outcomes. Several small randomized controlled trials (RCTs) have recently shown that in patients with chronic kidney disease (CKD), furosemide-induced forced diuresis with matched hydration using the RenalGuard system can prevent its occurrence. However, individual studies have been underpowered and thus cannot show significant differences in major clinical endpoints. HYPOTHESIS Forced diuresis with matched hydration using the RenalGuard system improves clinical outcomes in patients undergoing coronary angiography. METHODS Scientific databases and websites were searched for relevant RCTs. The pooled risk ratios were calculated using random-effects models. The primary endpoint was CIN, and the secondary endpoints were major adverse clinical events (MACEs) and the need for renal replacement therapy. RESULTS Data from 3 trials including 586 patients were analyzed. High-volume forced diuresis with matched hydration using the RenalGuard system decreased risk of CIN by 60% (risk ratio: 0.40, 95% confidence interval: 0.25 to 0.65, P < 0.001), MACE rate by 59%, and the need for renal replacement therapy by 78%, compared with the standard of care. CONCLUSIONS In patients with CKD undergoing coronary angiography, high-volume forced diuresis with matched hydration using the RenalGuard system significantly reduces the risk of CIN, MACE rate, and the need for renal replacement therapy. Larger RCTs with sufficient power are needed to confirm these findings.
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Affiliation(s)
- Rahman Shah
- Department of Medicine, Division of Cardiology, University of Tennessee, Memphis
| | - Sarah J Wood
- Department of Medicine, Division of Cardiology, University of Tennessee, Memphis
| | - Sajjad A Khan
- Department of Medicine, Aga Khan University Medical School, Karachi, Pakistan
| | - Amina Chaudhry
- Department of Medicine, Division of Cardiology, University of Tennessee, Memphis
| | - M Rehan Khan
- Department of Radiology, Veterans Affairs Medical Center, Richmond, Virginia
| | - Mohamed S Morsy
- Department of Medicine, Division of Cardiology, University of Tennessee, Memphis
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A Novel Pretreatment Regimen for Breakthrough Radiocontrast Media Anaphylaxis in Cardiac Patients. Crit Pathw Cardiol 2017; 15:161-164. [PMID: 27846008 DOI: 10.1097/hpc.0000000000000088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Radiocontrast media allergy is a severe and potentially life-threatening condition. This creates a clinical dilemma for cardiac patients who require urgent interventions with radiocontrast media. Several pretreatment regimens have been suggested for patients with prior immediate hypersensitivity reactions to radiocontrast media. Despite using pretreatment regimens, breakthrough reactions have been reported in 2.1%-18% of patients with radiocontrast media allergy. Little is known about management of patients with a history of breakthrough radiocontrast media anaphylaxis who require urgent lifesaving procedures. METHODS We report a retrospective analysis of 2 cardiac cases with a history of breakthrough radiocontrast media anaphylaxis despite standard pretreatment. These patients required urgent cardiac intervention with the use of radiocontrast media. RESULTS We present a novel pretreatment regimen for high-risk cardiac patients with breakthrough radiocontrast media anaphylaxis despite prior pretreatment who need urgent coronary interventions. CONCLUSION This protocol is both safe and effective in mitigating anaphylaxis in cardiac patients.
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Sapontis J, Barron G, Seneviratne S, Fuernau G, Eitel I, Ledwoch J, Thiele H, Saad M, de Waha S, Poess J, Desch S. A first in human evaluation of a novel contrast media saving device. Catheter Cardiovasc Interv 2017; 90:928-934. [DOI: 10.1002/ccd.27033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/03/2017] [Accepted: 02/25/2017] [Indexed: 11/10/2022]
Affiliation(s)
- James Sapontis
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health & Department of Medicine (SCS at Monash); Monash University; Melbourne Australia
| | - Garry Barron
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health & Department of Medicine (SCS at Monash); Monash University; Melbourne Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health & Department of Medicine (SCS at Monash); Monash University; Melbourne Australia
| | - Georg Fuernau
- University Heart Centre Lübeck, Department of Cardiology; Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein; Lübeck Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck; Lübeck Germany
| | - Ingo Eitel
- University Heart Centre Lübeck, Department of Cardiology; Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein; Lübeck Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck; Lübeck Germany
| | - Jakob Ledwoch
- University Heart Centre Lübeck, Department of Cardiology; Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein; Lübeck Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck; Lübeck Germany
| | - Holger Thiele
- University Heart Centre Lübeck, Department of Cardiology; Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein; Lübeck Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck; Lübeck Germany
| | - Mohammed Saad
- University Heart Centre Lübeck, Department of Cardiology; Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein; Lübeck Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck; Lübeck Germany
| | - Suzanne de Waha
- University Heart Centre Lübeck, Department of Cardiology; Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein; Lübeck Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck; Lübeck Germany
| | - Janine Poess
- University Heart Centre Lübeck, Department of Cardiology; Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein; Lübeck Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck; Lübeck Germany
| | - Steffen Desch
- University Heart Centre Lübeck, Department of Cardiology; Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein; Lübeck Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck; Lübeck Germany
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Sadineni R, Karthik KR, Swarnalatha G, Das U, Taduri G. N-acetyl cysteine versus allopurinol in the prevention of contrast nephropathy in patients with chronic kidney disease: A randomized controlled trial. Indian J Nephrol 2017; 27:93-98. [PMID: 28356658 PMCID: PMC5358166 DOI: 10.4103/0971-4065.194397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Contrast media administration can lead to acute deterioration in renal function particularly in patients with pre-existing chronic kidney disease. This prospective, randomized controlled open-label parallel group study was undertaken at Nizam's Institute of Medical Sciences, Hyderabad, from June to December 2015. A total of 95 patients were included, of which 35 received n-acetylcysteine (NAC) + normal saline (NS), 30 patients received allopurinol (ALL) + NS, and 30 patients received placebo. In our study, the overall incidence of CIN was 24%. Incidence of CIN in NAC + NS, ALL + NS, and placebo group were 20%, 16%, and 36%, respectively. The major finding of this study was there was no significant difference between NAC and allopurinol in the prevention of contrast nephropathy. However, only allopurinol was superior to placebo. In our study, hyperuricemia and baseline serum creatinine were the only risk factors associated with CIN.
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Affiliation(s)
- R Sadineni
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - K R Karthik
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - G Swarnalatha
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - U Das
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - G Taduri
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Prasad A, Sohn A, Morales J, Williams K, Bailey SR, Levin D, McCullough PA, Mehran R, Lopez-Cruz G, Harder J. Contemporary practice patterns related to the risk of acute kidney injury in the catheterization laboratory: Results from a survey of Society of Cardiovascular Angiography and Intervention (SCAI) cardiologists. Catheter Cardiovasc Interv 2016; 89:383-392. [DOI: 10.1002/ccd.26628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/01/2016] [Accepted: 05/23/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Anand Prasad
- Department of Medicine, Division of Cardiology; The University of Texas Health Science Center San Antonio; San Antonio Texas
| | - Aaron Sohn
- Department of Medicine, Division of Cardiology; The University of Texas Health Science Center San Antonio; San Antonio Texas
| | - Jonathan Morales
- Department of Medicine, Division of Cardiology; The University of Texas Health Science Center San Antonio; San Antonio Texas
| | - Ken Williams
- Department of Medicine, Division of Cardiology; The University of Texas Health Science Center San Antonio; San Antonio Texas
| | - Steven R. Bailey
- Department of Medicine, Division of Cardiology; The University of Texas Health Science Center San Antonio; San Antonio Texas
| | - Daniel Levin
- Department of Medicine, Division of Cardiology; The University of Texas Health Science Center San Antonio; San Antonio Texas
| | | | - Roxana Mehran
- Department of Medicine, Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai; Mount Sinai
| | | | - Joel Harder
- The Society of Cardiovascular Angiography and Interventions; Washington, DC
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Naidu SS, Aronow HD, Box LC, Duffy PL, Kolansky DM, Kupfer JM, Latif F, Mulukutla SR, Rao SV, Swaminathan RV, Blankenship JC. SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory: (Endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologia intervencionista; Affirmation of value by the Canadian Associatio. Catheter Cardiovasc Interv 2016; 88:407-23. [DOI: 10.1002/ccd.26551] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Srihari S. Naidu
- Division of Cardiology, Winthrop University Hospital, Mineola, New York
| | - Herbert D. Aronow
- Warren Alpert Medical School of Brown University, Cardiovascular Institute, Providence, RI
| | | | | | - Daniel M. Kolansky
- Cardiovascular Medicine Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel M. Kupfer
- University of Illinois School of Medicine-Peoria, Peoria, IL
| | - Faisal Latif
- University of Oklahoma and VA Medical Center, Oklahoma City, OK
| | - Suresh R. Mulukutla
- University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | | - Rajesh V. Swaminathan
- Weill Cornell Medical College, New York-Presbyterian Hospital, Greenberg Division of Cardiology, New York, NY
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Agarwal SK, Mohareb S, Patel A, Yacoub R, DiNicolantonio JJ, Konstantinidis I, Pathak A, Fnu S, Annapureddy N, Simoes PK, Kamat S, El-Hayek G, Prasad R, Kumbala D, Nascimento RM, Reilly JP, Nadkarni GN, Benjo AM. Systematic oral hydration with water is similar to parenteral hydration for prevention of contrast-induced nephropathy: an updated meta-analysis of randomised clinical data. Open Heart 2015; 2:e000317. [PMID: 26468404 PMCID: PMC4600249 DOI: 10.1136/openhrt-2015-000317] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/02/2015] [Accepted: 09/08/2015] [Indexed: 11/29/2022] Open
Abstract
Background Contrast-induced nephropathy (CIN) is the third most common cause of hospital-acquired kidney injury and is related to increased long-term morbidity and mortality. Adequate intravenous (IV) hydration has been demonstrated to lessen its occurrence. Oral (PO) hydration with water is inexpensive and readily available but its role for CIN prevention is yet to be determined. Methods PubMed, EMBASE and the Cochrane Central register of controlled trials (CENTRAL) databases were searched until April 2015 and studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. All randomised clinical trials with head-to-head comparison between PO and IV hydration were included. Results A total of 5 studies with 477 patients were included in the analysis, 255 of those receiving PO water. The incidence of CIN was statistically similar in the IV and PO arms (7.7% and 8.2%, respectively; relative risk 0.97; 95% CI 0.36 to 2.94; p=0.95). The incidence of CIN was statistically similar in the IV and PO arms in patients with chronic kidney disease and with normal renal function. Rise in creatinine at 48–72 h was lower in the PO hydration group compared with IV hydration (pooled standard mean difference 0.04; 95% CI 0.03 to 0.06; p<0.001; I2=62%). Conclusions Our meta-analysis shows that systematic PO hydration with water is at least as effective as IV hydration with saline to prevent CIN. PO hydration is cheaper and more easily administered than IV hydration, thus making it more attractive and just as effective.
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Affiliation(s)
- Shiv Kumar Agarwal
- Division of Cardiovascular Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas , USA
| | - Sameh Mohareb
- Division of Cardiology, Department of Internal Medicine , Ochsner Clinic Foundation , New Orleans, Louisiana , USA
| | - Achint Patel
- Department of Public Health , Icahn School of Medicine at Mount Sinai , New York, New York , USA
| | - Rabi Yacoub
- Division of Nephrology, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York, New York , USA
| | | | - Ioannis Konstantinidis
- Department of Medicine , Icahn School of Medicine at Mount Sinai , New York, New York , USA
| | - Ambarish Pathak
- Department of Public Health , New York Medical College , Valhalla, New York , USA
| | - Shailesh Fnu
- Division of Cardiovascular Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas , USA
| | - Narender Annapureddy
- Division of Rheumatology, Department of Medicine , Vanderbilt University Medical Center , Nashville, Tennessee , USA
| | - Priya K Simoes
- Department of Medicine , St Lukes Roosevelt Hospital Center at Mount Sinai , New York, New York , USA
| | - Sunil Kamat
- Division of Critical Care , Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute , Mumbai, Maharashtra , India
| | - Georges El-Hayek
- Department of Medicine , St Lukes Roosevelt Hospital Center at Mount Sinai , New York, New York , USA
| | - Ravi Prasad
- Division of Cardiology, Department of Internal Medicine , Ochsner Clinic Foundation , New Orleans, Louisiana , USA
| | - Damodar Kumbala
- Division of Nephrology, Department of Internal Medicine , Ochsner Clinic Foundation , New Orleans, Louisiana , USA
| | | | - John P Reilly
- Division of Cardiology, Department of Internal Medicine , Ochsner Clinic Foundation , New Orleans, Louisiana , USA
| | - Girish N Nadkarni
- Division of Nephrology, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York, New York , USA
| | - Alexandre M Benjo
- Division of Cardiology, Department of Internal Medicine , Ochsner Clinic Foundation , New Orleans, Louisiana , USA
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Kırat T, Köse N, Altun İ, Akın F. The thrombogenic potential of contrast media and thrombotic complications after coronary angiography. Int J Cardiol 2015; 194:1. [DOI: 10.1016/j.ijcard.2015.05.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
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Swapnil H, Knoll GA, Kayibanda JF, Fergusson D, Chow BJ, Shabana W, Murphy E, Ramsay T, James M, White CA, Garg A, Wald R, Hoch J, Akbari A. Oral salt and water versus intravenous saline for the prevention of acute kidney injury following contrast-enhanced computed tomography: study protocol for a pilot randomized trial. Can J Kidney Health Dis 2015; 2:12. [PMID: 25883789 PMCID: PMC4399084 DOI: 10.1186/s40697-015-0048-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/02/2015] [Indexed: 11/17/2022] Open
Abstract
Background Although intravenous saline is the accepted prophylactic measure for the prevention of contrast- induced acute kidney injury, the oral route could offer an equivalent, practical, and cost saving approach. A systematic review of randomized trials that compared oral versus intravenous volume expansion for the prevention of radiocontrast-induced nephropathy in patients receiving arterial contrast reported no significant difference in the risk of contrast induced acute kidney injury between the oral and intravenous arms. Most trials for contrast nephropathy prevention have been in the setting of arterial contrast such as with cardiac catheterization, and not with venous contrast, such as computed tomography. The aim of this paper is to describe the protocol of a pilot trial comparing the effect of oral salt and water versus intravenous saline on the prevention of Acute Kidney Injury following contrast-enhanced computed tomography. Methods Our study is a pilot, single-centre parallel randomized controlled trial. To be included, participants must be at stage 4 of chronic kidney disease as defined by a glomerular filtration rate <30 mL/min/1.73 m2, aged greater than 18 years and to undergo an outpatient contrast-enhanced computer tomography of the chest or abdomen. A total 50 patients will be randomised to receive either oral salt and water or intravenous isotonic saline. The primary outcome is feasibility, including estimates of recruitment rate, adherence to intervention and completeness of follow-up to assist in planning the definitive trial. The secondary outcome is safety and includes adverse events with oral salt and water loading as compared to intravenous isotonic saline. Discussion The results of this pilot trial will provide critical information to plan a definitive trial to test the efficacy of the route of volume loading regimens in prevention of acute kidney injury after contrast-enhanced CT scans. Trial registration The trial is registered at the US National Institutes of Health (ClinicalTrials.gov) # NCT02084771.
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Affiliation(s)
- Hiremath Swapnil
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada ; Division of Nephrology, The Ottawa Hospital, Riverside Campus, 1967 Riverside Drive, Ottawa, Ontario K1H 7 W9 Canada
| | - Greg A Knoll
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Benjamin Jw Chow
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Wael Shabana
- Department of Medical Imaging, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Erin Murphy
- Ottawa Health Research Institute, Ottawa Hospital, Ottawa, Canada
| | - Tim Ramsay
- Faculty of Medicine, Epidemiology& Community Medicine, University of Ottawa, Ottawa, Canada
| | - Matthew James
- Departments of Medicine and Community Health Sciences, University of Calgary, Alberta, Canada
| | - Christine A White
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Canada
| | - Amit Garg
- Division of Nephrology, Department of Medicine, University of Western Ontario, London, Canada
| | - Ron Wald
- Division of Nephrology, Department of Medicine, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Jeffrey Hoch
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Ayub Akbari
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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Lee JM, Park J, Jeon KH, Jung JH, Lee SE, Han JK, Kim HL, Yang HM, Park KW, Kang HJ, Koo BK, Jo SH, Kim HS. Efficacy of short-term high-dose statin pretreatment in prevention of contrast-induced acute kidney injury: updated study-level meta-analysis of 13 randomized controlled trials. PLoS One 2014; 9:e111397. [PMID: 25369120 PMCID: PMC4219719 DOI: 10.1371/journal.pone.0111397] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There have been conflicting results across the trials that evaluated prophylactic efficacy of short-term high-dose statin pre-treatment for prevention of contrast-induced acute kidney injury (CIAKI) in patients undergoing coronary angiography (CAG). The aim of the study was to perform an up-to-date meta-analysis regarding the efficacy of high-dose statin pre-treatment in preventing CIAKI. METHODS AND RESULTS Randomized-controlled trials comparing high-dose statin versus low-dose statin or placebo pre-treatment for prevention of CIAKI in patients undergoing CAG were included. The primary endpoint was the incidence of CIAKI within 2-5 days after CAG. The relative risk (RR) with 95% CI was the effect measure. This analysis included 13 RCTs with 5,825 total patients; about half of them (n = 2,889) were pre-treated with high-dose statin (at least 40 mg of atorvastatin) before CAG, and the remainders (n = 2,936) pretreated with low-dose statin or placebo. In random-effects model, high-dose statin pre-treatment significantly reduced the incidence of CIAKI (RR 0.45, 95% CI 0.35-0.57, p<0.001, I(2)= 8.2%, NNT 16), compared with low-dose statin or placebo. The benefit of high-dose statin was consistent in both comparisons with low-dose statin (RR 0.47, 95% CI 0.34-0.65, p<0.001, I(2) = 28.4%, NNT 19) or placebo (RR 0.34, 95% CI 0.21-0.58, p<0.001, I(2)= 0.0%, NNT 16). In addition, high-dose statin showed significant reduction of CIAKI across various subgroups of chronic kidney disease, acute coronary syndrome, and old age (≥ 60 years), regardless of osmolality of contrast or administration of N-acetylcystein. CONCLUSIONS High-dose statin pre-treatment significantly reduced overall incidence of CIAKI in patients undergoing CAG, and emerges as an effective prophylactic measure to prevent CIAKI.
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Affiliation(s)
- Joo Myung Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jonghanne Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Ki-Hyun Jeon
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Ji-hyun Jung
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sang Eun Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hack-Lyoung Kim
- Cardiovascular Center, Seoul National University, Boramae Medical Center, Seoul, Korea
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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Karmpaliotis D, Lembo N, Kalynych A, Carlson H, Lombardi WL, Anderson CN, Rinehart S, Kirkland B, Shemwell KC, Kandzari DE. Development of a high-volume, multiple-operator program for percutaneous chronic total coronary occlusion revascularization: procedural, clinical, and cost-utilization outcomes. Catheter Cardiovasc Interv 2013; 82:1-8. [DOI: 10.1002/ccd.24387] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 02/12/2012] [Accepted: 02/20/2012] [Indexed: 11/06/2022]
Affiliation(s)
| | - Nicholas Lembo
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - Anna Kalynych
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - Harold Carlson
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - William L. Lombardi
- PeaceHealth St. Joseph Medical Center; 29779 Squalicum Parkway Suite 101; Bellingham; WA 98225
| | - Chad N. Anderson
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - Sarah Rinehart
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - Ben Kirkland
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - Kathie C. Shemwell
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
| | - David E. Kandzari
- Piedmont Heart Institute; Suite 300, 275 Collier Road; Atlanta; GA 30309
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Hiremath S, Akbari A, Shabana W, Fergusson DA, Knoll GA. Prevention of contrast-induced acute kidney injury: is simple oral hydration similar to intravenous? A systematic review of the evidence. PLoS One 2013; 8:e60009. [PMID: 23555863 PMCID: PMC3608617 DOI: 10.1371/journal.pone.0060009] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/20/2013] [Indexed: 01/08/2023] Open
Abstract
Background Pre-procedural intravenous fluid administration is an effective prophylaxis measure for contrast-induced acute kidney injury. For logistical ease, the oral route is an alternative to the intravenous. The objective of this study was to compare the efficacy of the oral to the intravenous route in prevention of contrast-induced acute kidney injury. Study Design A systematic review and meta-analysis of randomised trials with a stratified analysis and metaregression. Databases included MEDLINE (1950 to November 23 2011), EMBASE (1947 to week 47 2011), Cochrane CENTRAL (3rd quarter 2011). Two reviewers identified relevant trials and abstracted data. Settings and Population Trials including patients undergoing a contrast enhanced procedure. Selection Criteria Randomised controlled trial; adult (>18 years) population; comparison of oral versus intravenous volume expansion. Intervention Oral route of volume expansion compared to the intravenous route. Outcomes Any measure of acute kidney injury, need for renal replacement therapy, hospitalization and death. Results Six trials including 513 patients met inclusion criteria. The summary odds ratio was 1.19 (95% CI 0.46, 3.10, p = 0.73) suggesting no difference between the two routes of volume expansion. There was significant heterogeneity (Cochran’s Q = 11.65, p = 0.04; I2 = 57). In the stratified analysis, inclusion of the five studies with a prespecified oral volume expansion protocol resulted in a shift towards oral volume expansion (OR 0.75, 95% CI 0.37, 1.50, p = 0.42) and also resolved the heterogeneity (Q = 3.19, P = 0.53; I2 = 0). Limitations Small number of studies identified; lack of hard clinical outcomes. Conclusion The oral route may be as effective as the intravenous route for volume expansion for contrast-induced acute kidney injury prevention. Adequately powered trials with hard endpoints should be done given the potential advantages of oral (e.g. reduced patient burden and cost) over intravenous volume expansion.
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Affiliation(s)
- Swapnil Hiremath
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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Li WH, Li DY, Han F, Xu TD, Zhang YB, Zhu H. Impact of anemia on contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary interventions. Int Urol Nephrol 2012; 45:1065-70. [PMID: 23225080 PMCID: PMC3732774 DOI: 10.1007/s11255-012-0340-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 11/16/2012] [Indexed: 12/26/2022]
Abstract
Background The aim of the present study was to assess the influence of anemia on the risk of developing contrast-induced nephropathy after percutaneous coronary angioplasty. Methods Serum creatinine values were measured before and within 48 h after the administration of contrast agents. Contrast-induced nephropathy (CIN) was defined as an increase of ≥0.5 mg/dl or ≥25 % in serum creatinine concentration over baseline within 48 h after administration. Anemia was defined as hemoglobin <120 g/l in women and <130 g/l in men. Results Among the 1,026 patients studied, 32 (3.1 %) developed CIN after procedure. CIN occurred in 6.3 % of the anemic patients and in 2.2 % of the non-anemic patients (P < 0.01). The incidence of CIN increased with decreasing of baseline estimated glomerular filtration rate (eGFR) in both the anemia and non-anemia groups. In patients with baseline eGFR <30 ml/min, a high proportion of both anemic and non-anemic patients experienced CIN (24.6 vs. 17.5 %). When baseline eGFR was 30–59 ml/min, the incidence of CIN in anemic patients was twofold higher than in non-anemic patients (7.9 vs. 3.8 %; P < 0.05). Multivariate logistic regression analysis found that baseline eGFR and baseline hemoglobin were independent predictors of CIN. Conclusion Anemia is associated with a higher incidence of CIN in patients with moderate renal dysfunction. Patients with both preexisting renal insufficiency and anemia are at high risk of CIN. Baseline eGFR and baseline hemoglobin are independent predictors of CIN.
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Affiliation(s)
- Wen-hua Li
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical College, No. 99 Huihai west Road, Xuzhou, 221002, China.
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2012; 79:453-95. [PMID: 22328235 DOI: 10.1002/ccd.23438] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Hung YM, Lin SL, Hung SY, Huang WC, Wang PYP. Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography. World J Cardiol 2012; 4:157-72. [PMID: 22655164 PMCID: PMC3364502 DOI: 10.4330/wjc.v4.i5.157] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 03/16/2012] [Accepted: 03/23/2012] [Indexed: 02/06/2023] Open
Abstract
Radiocontrast-induced nephropathy (RCIN) is an acute and severe complication after coronary angiography, particularly for patients with pre-existing chronic kidney disease (CKD). It has been associated with both short- and long-term adverse outcomes, including the need for renal replacement therapy, increased length of hospital stay, major cardiac adverse events, and mortality. RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25% above baseline within 48 h after contrast administration. There is no effective therapy once injury has occurred, therefore, prevention is the cornerstone for all patients at risk for acute kidney injury (AKI). There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes. The optimal strategy for preventing RCIN has not yet been established. This review discusses the principal risk factors for RCIN, evaluates and summarizes the evidence for RCIN prophylaxis, and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography.
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Affiliation(s)
- Yao-Min Hung
- Yao-Min Hung, Division of Nephrology, Jiannren Hospital, Kaohsiung 813, Taiwan, China
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Chambers CE. Contrast-induced nephropathy is not preventable. Catheter Cardiovasc Interv 2012; 79:76-7. [PMID: 22190207 DOI: 10.1002/ccd.23492] [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] [Indexed: 11/08/2022]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary. J Am Coll Cardiol 2011. [DOI: 10.1016/j.jacc.2011.08.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Blankenship JC, Moussa ID, Chambers CC, Brilakis ES, Haldis TA, Morrison DA, Dehmer GJ. Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2011; 79:1138-52. [DOI: 10.1002/ccd.23353] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 08/12/2011] [Indexed: 01/09/2023]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:2574-609. [PMID: 22064598 DOI: 10.1161/cir.0b013e31823a5596] [Citation(s) in RCA: 381] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58:e44-122. [PMID: 22070834 DOI: 10.1016/j.jacc.2011.08.007] [Citation(s) in RCA: 1724] [Impact Index Per Article: 132.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574-651. [PMID: 22064601 DOI: 10.1161/cir.0b013e31823ba622] [Citation(s) in RCA: 902] [Impact Index Per Article: 69.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Catheter Cardiovasc Interv 2011; 82:E266-355. [DOI: 10.1002/ccd.23390] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bellemain-Appaix A, Beygui F, Lesty C, Gupta S, Silvain J, Le Feuvre C, Cayla G, Allali Y, Montalescot G, Collet JP. Impact of anticoagulation on ionic and nonionic contrast media effect on thrombogenesis and fibrinolysis: The PEPCIT study. Catheter Cardiovasc Interv 2011; 79:823-33. [DOI: 10.1002/ccd.23080] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 02/19/2011] [Indexed: 11/10/2022]
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Klein LW, Uretsky BF, Chambers C, Anderson HV, Hillegass WB, Singh M, Ho KKL, Rao SV, Reilly J, Weiner BH, Kern M, Bailey S. Quality assessment and improvement in interventional cardiology: a position statement of the Society of Cardiovascular Angiography and Interventions, part 1: standards for quality assessment and improvement in interventional cardiology. Catheter Cardiovasc Interv 2011; 77:927-35. [PMID: 21370384 DOI: 10.1002/ccd.22982] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 01/08/2011] [Indexed: 11/07/2022]
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Caixeta A, Mehran R. Evidence-based management of patients undergoing PCI: contrast-induced acute kidney injury. Catheter Cardiovasc Interv 2010; 75 Suppl 1:S15-20. [PMID: 20333702 DOI: 10.1002/ccd.22376] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is one of the leading causes of hospital-acquired acute kidney injury. CI-AKI is highly prevalent in patients with well-known risk factors, including older age, chronic renal insufficiency, congestive heart failure, and diabetes. Thus far, no strategies have been shown to be effective in preventing CI-AKI beyond thorough patient selection, minimizing the amount of contrast agent, and meticulous hydration of the patient. The role of various drugs in preventing CI-AKI is still controversial and warrants future studies. Despite the remaining uncertainty regarding the degree of nephrotoxicity produced by various contrast agents, nonionic low-osmolar contrast media may be preferred in patients at high risk for CI-AKI.
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Affiliation(s)
- Adriano Caixeta
- Columbia University Medical Center, Cardiovascular Research Foundation, New York, New York 10022, USA
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