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Elahimanesh M, Shokri N, Mahdinia E, Mohammadi P, Parvaz N, Najafi M. Differential gene expression patterns in ST-elevation Myocardial Infarction and Non-ST-elevation Myocardial Infarction. Sci Rep 2024; 14:3424. [PMID: 38341440 PMCID: PMC10858964 DOI: 10.1038/s41598-024-54086-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/08/2024] [Indexed: 02/12/2024] Open
Abstract
The ST-elevation Myocardial Infarction (STEMI) and Non-ST-elevation Myocardial Infarction (NSTEMI) might occur because of coronary artery stenosis. The gene biomarkers apply to the clinical diagnosis and therapeutic decisions in Myocardial Infarction. The aim of this study was to introduce, enrich and estimate timely the blood gene profiles based on the high-throughput data for the molecular distinction of STEMI and NSTEMI. The text mining data (50 genes) annotated with DisGeNET data (144 genes) were merged with the GEO gene expression data (5 datasets) using R software. Then, the STEMI and NSTEMI networks were primarily created using the STRING server, and improved using the Cytoscape software. The high-score genes were enriched using the KEGG signaling pathways and Gene Ontology (GO). Furthermore, the genes were categorized to determine the NSTEMI and STEMI gene profiles. The time cut-off points were identified statistically by monitoring the gene profiles up to 30 days after Myocardial Infarction (MI). The gene heatmaps were clearly created for the STEMI (high-fold genes 69, low-fold genes 45) and NSTEMI (high-fold genes 68, low-fold genes 36). The STEMI and NSTEMI networks suggested the high-score gene profiles. Furthermore, the gene enrichment suggested the different biological conditions for STEMI and NSTEMI. The time cut-off points for the NSTEMI (4 genes) and STEMI (13 genes) gene profiles were established up to three days after Myocardial Infarction. The study showed the different pathophysiologic conditions for STEMI and NSTEMI. Furthermore, the high-score gene profiles are suggested to measure up to 3 days after MI to distinguish the STEMI and NSTEMI.
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Affiliation(s)
- Mohammad Elahimanesh
- Clinical Biochemistry Department, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Shokri
- Clinical Biochemistry Department, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Elmira Mahdinia
- Clinical Biochemistry Department, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Payam Mohammadi
- Clinical Biochemistry Department, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Najmeh Parvaz
- Clinical Biochemistry Department, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Najafi
- Clinical Biochemistry Department, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran.
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran.
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2
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Toprak K. Effect of Serum C-Peptide Levels on the Development of Contrast-Induced Nephropathy in Diabetic Patients Undergoing Coronary Angiography. Angiology 2024; 75:139-147. [PMID: 36303403 DOI: 10.1177/00033197221132359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Contrast-induced nephropathy (CIN) is an important cause of morbidity and mortality, in patients with diabetes who undergo coronary angiography (CAG). It is known that serum C-peptide has renoprotective effects in diabetic nephropathy. Patients with diabetes (n = 552) who underwent CAG in our center between January 2020 and December 2021 were included, retrospectively. The patients were divided into 2 groups: not-developing CIN (group 1) and developing CIN (group 2). CIN developed in 128 (23.1%) of the patients with diabetes who underwent CAG. C-peptide, albumin, hemoglobin, hematocrit, initial creatinine, ejection fraction (EF), were significantly lower in the group that developed CIN compared with the group that did not (P < .05, for all). In correlation analysis, creatinine increase rate (ΔCr) was negatively correlated with C-peptide, hematocrit, and ejection fraction (r = -.241, P < .001; r = -.135, P < .001; r = -.194, P = .001; respectively). In logistic regression analysis, C-peptide level (Odds Ratio: .404, 95% Confidence Interval: .286-.571, P < .001) was an independent predictor of CIN. In the present study, C-peptide level was an independent predictor of CIN in patients with diabetes. This study suggests that low levels of C-peptide are associated with a greater risk of CIN.
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Affiliation(s)
- Kenan Toprak
- Siverek State Hospital and Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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3
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Landi A, Branca M, Leonardi S, Frigoli E, Vranckx P, Tebaldi M, Varbella F, Calabró P, Esposito G, Sardella G, Garducci S, Andò G, Limbruno U, Sganzerla P, Santarelli A, Briguori C, Colangelo S, Brugaletta S, Adamo M, Omerovic E, Heg D, Windecker S, Valgimigli M. Transient vs In-Hospital Persistent Acute Kidney Injury in Patients With Acute Coronary Syndrome. JACC Cardiovasc Interv 2023; 16:193-205. [PMID: 36697156 DOI: 10.1016/j.jcin.2022.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The occurrence of acute kidney injury (AKI) among patients with acute coronary syndrome (ACS) undergoing invasive management is associated with worse outcomes. However, the prognostic implications of transient or in-hospital persistent AKI may differ. OBJECTIVES The aim of this study was to evaluate the prognostic implications of transient or in-hospital persistent AKI in patients with ACS. METHODS In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial, 203 subjects were excluded because of incomplete information or end-stage renal disease, with a study population of 8,201 patients. Transient and persistent AKI were defined as renal dysfunction no longer or still fulfilling the AKI criteria (>0.5 mg/dL or a relative >25% increase in creatinine) at discharge, respectively. Thirty-day coprimary outcomes were the out-of-hospital composite of death, myocardial infarction, or stroke (major adverse cardiovascular events [MACE]) and net adverse cardiovascular events (NACE), defined as the composite of MACE or Bleeding Academic Research Consortium type 3 or 5 bleeding. RESULTS Persistent and transient AKI occurred in 750 (9.1%) and 587 (7.2%) subjects, respectively. After multivariable adjustment, compared with patients without AKI, the risk for 30-day coprimary outcomes was higher in patients with persistent AKI (MACE: adjusted HR: 2.32; 95% CI: 1.48-3.64; P < 0.001; NACE: adjusted HR: 2.29; 95% CI: 1.48-3.52; P < 0.001), driven mainly by all-cause mortality (adjusted HR: 3.43; 95% CI: 2.03-5.82; P < 0.001), whereas transient AKI was not associated with higher rates of MACE or NACE. Results remained consistent when implementing the KDIGO (Kidney Disease Improving Global Outcomes) criteria. CONCLUSIONS Among patients with ACS undergoing invasive management, in-hospital persistent but not transient AKI was associated with higher risk for 30-day MACE and NACE. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox [MATRIX]; NCT01433627).
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Affiliation(s)
- Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Frigoli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; CTU Bern, University of Bern, Switzerland
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Ferdinando Varbella
- Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3, Turin, Italy; Cardiology Unit, Azienda Ospedaliera Universitaria San Luigi Gonzaga Orbassano, Turin, Italy
| | - Paolo Calabró
- Division of Cardiology, "Sant'Anna e San Sebastiano" Hospital, Caserta, Italy; Department of Translational Medicine, University of Campania "Luigi Vanvitelli," Caserta, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Gennaro Sardella
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Giuseppe Andò
- Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino," University of Messina, Messina, Italy
| | - Ugo Limbruno
- Cardiology Department, Misericordia Hospital, Grosseto, Italy
| | - Paolo Sganzerla
- IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milano
| | | | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | | | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dik Heg
- CTU Bern, University of Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland.
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4
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Isaac T, Gilani S, Kleiman NS. When Prevention is Truly Better than Cure: Contrast-Associated Acute Kidney Injury in Percutaneous Coronary Intervention. Methodist Debakey Cardiovasc J 2022; 18:73-85. [PMID: 36132584 PMCID: PMC9461685 DOI: 10.14797/mdcvj.1136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/01/2022] [Indexed: 11/08/2022] Open
Abstract
Contrast-associated acute kidney injury (CA-AKI) is a fairly frequent complication of cardiovascular angiography and percutaneous coronary intervention (PCI). The risk is significantly higher in patients with advanced chronic kidney disease (CKD). Prevention is the only option for avoiding the significant morbidity and mortality associated with CA-AKI. This review provides a concise and clinically directed appraisal of the latest pre-procedural and peri-procedural strategies to minimize the risk of CA-AKI in all patients undergoing PCI. By broadly implementing these evidence-based care bundles, we can dramatically improve outcomes in this vulnerable patient population.
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Affiliation(s)
- Tea Isaac
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Salima Gilani
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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5
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Mandurino-Mirizzi A, Munafò A, Crimi G. Contrast-Associated Acute Kidney Injury. J Clin Med 2022; 11:jcm11082167. [PMID: 35456260 PMCID: PMC9027950 DOI: 10.3390/jcm11082167] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 01/25/2023] Open
Abstract
Contrast-associated acute kidney injury (CA-AKI) is an impairment of renal function, which occurs within days of intravascular administration of iodinated contrast media. Taking into account that minimally invasive cardiac interventions are becoming increasingly popular, compared to traditional surgery, given their impact on prognosis and costs, CA-AKI remains a subject of increasing interest for patients and physicians. This review summarizes the epidemiology and risk stratification, diagnostic criteria, pathophysiology and clinical implications of CA-AKI, providing evidence for the most studied preventive strategies.
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Affiliation(s)
| | - Andrea Munafò
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.M.-M.); (A.M.)
| | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, 16100 Genova, Italy
- IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, 16100 Genova, Italy
- Correspondence: ; Tel.: +39-3479345112
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6
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Heger LA, Glück T, Kaier K, Hortmann M, Rieder M, Siegel PM, Diehl P, Wengenmayer T, Olivier CB, Bode C, Busch HJ, Duerschmied D, Ahrens I. Medical history of coronary artery disease and time to electrocardiogram in the emergency department: a real-life, single-center, retrospective analysis. BMC Cardiovasc Disord 2021; 21:480. [PMID: 34620090 PMCID: PMC8496093 DOI: 10.1186/s12872-021-02274-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/26/2021] [Indexed: 11/15/2022] Open
Abstract
Background Timely acquisition of 12-lead Electrocardiogram (ECG) in the emergency department (ED) is crucial and recommended by current guidelines.
Objectives To evaluate the association of medical history of coronary artery disease (hCAD) on door-to-ECG time in the ED. Methods In this single center, retrospective cohort study, patients admitted to ED for cardiac evaluation were grouped according to hCAD and no hCAD. The primary outcome was door-to-ECG time. A multivariate analysis adjusted for the cofounders sex, age, type of referral and shift was performed to evaluate the association of hCAD with door-to-ECG time. Results 1101 patients were included in this analysis. 362 patients (33%) had hCAD. Patients with hCAD had shorter door-to-ECG time (20 min. [Inter Quartile Range [IQR] 13–30] vs. 22 min. [IQR 14–37]; p < 0.001) when compared to patients with no hCAD. In a multivariable regression analysis hCAD was significantly associated with a shorter door-to-ECG time (− 3 min [p = 0.007; 95% confidence Interval [CI] − 5.16 to − 0.84 min]). Conclusion In this single center registry, hCAD was associated with shorter door-to-ECG time. In patients presenting in ED for cardiac evaluation, timely ECG diagnostic should be facilitated irrespective of hCAD.
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Affiliation(s)
- Lukas Andreas Heger
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Tina Glück
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcus Hortmann
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marina Rieder
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Patrick M Siegel
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Diehl
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph B Olivier
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hans-Joerg Busch
- Departement of Emergency Medicine, University Medical Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital, Academic Teaching Hospital University of Cologne, Cologne, Germany
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7
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Liu T, Lee SR. Poor Prognosis of Contrast-Induced Nephropathy during Long Term Follow Up. Chonnam Med J 2021; 57:197-203. [PMID: 34621640 PMCID: PMC8485089 DOI: 10.4068/cmj.2021.57.3.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/06/2022] Open
Abstract
Contrast-induced nephropathy (CIN) is known to associate with poor prognosis. However, there have been few studies for long-term follow up. The purpose of this study was to know the prognosis of CIN during a 10-year follow up. We retrospectively analyzed 528 patients who underwent coronary angiography in Jeonbuk National University Hospital (South Korea, Jeonju) between Jan 2005 to Dec 2006. We excluded the patients who required regular dialysis before study enrollment. We compared adverse events in the no CIN (group I, n=485, 61.9±11.4 years, male 64.1%) and CIN (group II, n=43, 65.7±11.1 years, male 62.8%). Baseline clinical characteristics and cardiovascular risk factors were not different between the two groups except the post-procedure creatinine level (1.04 mg/dL vs 1.84 mg/dL, p=0.0001). The higher rates of all-cause death were observed in group II at 1-year (3.7% vs 13.9%, log-rank, p=0.001), 5-years (17.9% vs 34.9%, log-rank, p=0.003), and 10-years (25.3% vs 48.8%, log-rank, p=0.000). MACE was higher in group II at 1-year (3.9% vs 11.6%, log-rank, p=0.013), 5-years (6.8% vs 20.9%, log-rank, p=0.000) and 10-years (13.4% vs 27.9%, log-rank, p=0.000). In addition, CIN was an independent predictor for 10-year MACE (adjusted HR 3.432, 95% CI 1.314-8.965, p=0.012) after propensity score matching. The worse prognosis of CIN was continuously observed after the 10-year follow-up. Our data suggests that it is worthwhile to prevent the appearance of CIN in order to improve longterm results.
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Affiliation(s)
- Taili Liu
- Division of Cardiology, Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Sang-Rok Lee
- Division of Cardiology, Department of Internal Medicine, Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
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8
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Liu J, Li Q, Lai D, Chen G, Wang B, Liu L, Huang H, Lun Z, Ying M, Chen G, Huang Z, Xu D, Meng L, Yan X, Qiu W, Tan N, Chen J, Liu Y, Chen S. Trends in incidence and long-term prognosis of acute kidney injury following coronary angiography in Chinese cohort with 11,943 patients from 2013 to 2017: an observational study. BMC Nephrol 2021; 22:235. [PMID: 34172005 PMCID: PMC8235610 DOI: 10.1186/s12882-021-02427-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Contrast-associated acute kidney injury (CA-AKI) is a common complication with poor prognosis after coronary angiography (CAG). With the prevention methods widely being implemented, the temporal trends of incidence and mortality of CA-AKI are still unknown over the last five years. The study aims to determine the incidence and prognosis of CA-AKI in China. Methods This retrospective cohort study was based on the registry at Guangdong Provincial People’s Hospital in China (ClinicalTrials.gov NCT04407936). We analyzed data from hospitalization patients who underwent CAG and with preoperative and postoperative serum creatinine (Scr) values from January 2013 to December 2017. Results 11,943 patients were included in the study, in which the mean age was 63.01 ± 10.79 years and 8,469 (71.1 %) were male. The overall incidence of CA-AKI was 11.2 %. Compared with 2013, the incidence of CA-AKI in 2017 was significantly increased from 9.7 to 13.0 % (adjusted odds ratios [aOR], 1.38; 95 %CI, 1.13–1.68; P-value < 0.01, P for trend < 0.01). The temporal trends of incidence among patients of different ages and genders yielded similar findings. During a standardized follow-up of 1 year, 178 (13.7 %) CA-AKI patients died in total, which showed no obvious decreased trend in this 5 five years from 21.1 to 16.5 (adjusted hazard ratio [aHR], 0.72; 95 %CI, 0.36–1.45; P-value = 0.35, P for trend = 0.24). Conclusions Our Chinese cohort showed that the incidence of CA-AKI increased significantly, while CA-AKI associated mortality showed no obvious decreased trend in the last five years. Our findings support more active measures to prevent CA-AKI and improve the prognosis of CA-AKI patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02427-6.
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Affiliation(s)
- Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China
| | - Qiang Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China
| | - Disheng Lai
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, 510100, Guangzhou, China
| | - Guoqin Chen
- Department of Cardiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Bo Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China
| | - Liwei Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, 510515, Guangzhou, China
| | - Haozhang Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, 510515, Guangzhou, China
| | - Zhubin Lun
- Department of Cardiology, Dongguan TCM Hospital, 523209, Dongguan, China
| | - Ming Ying
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China
| | - Guanzhong Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, 510100, Guangzhou, China
| | - Zhidong Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China
| | - Danyuan Xu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China
| | - Liangguang Meng
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China
| | - Xiaoming Yan
- Department of Information Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080, Guangzhou, China
| | - Weiyan Qiu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, 510515, Guangzhou, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, 510100, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, 510515, Guangzhou, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, 510100, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China. .,The Second School of Clinical Medicine, Southern Medical University, 510515, Guangzhou, China. .,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, 510100, Guangzhou, China.
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, South China University of Technology, 510080, Guangzhou, China.
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9
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Burlacu A, Tinica G, Brinza C, Crisan-Dabija R, Popa IV, Covic A. Safety and Efficacy of Minimum- or Zero-Contrast IVUS-Guided Percutaneous Coronary Interventions in Chronic Kidney Disease Patients: A Systematic Review. J Clin Med 2021; 10:jcm10091996. [PMID: 34066543 PMCID: PMC8125490 DOI: 10.3390/jcm10091996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/22/2021] [Accepted: 04/30/2021] [Indexed: 01/11/2023] Open
Abstract
Conventional percutaneous coronary interventions (PCIs) frequently cause severe complications in chronic kidney disease (CKD) patients. Low-to-zero contrast intravascular ultrasound (IVUS) guided PCIs are promising alternatives in the CKD setting. We aim to systematically review up-to-date literature that have reported data and outcomes of low-to-zero contrast PCIs performed in CKD patients. We searched Embase, PubMed, and Cochrane databases for full-text articles that reported original data regarding efficacy and/or safety outcomes of IVUS-guided PCIs in patients with CKD. The quality of non-randomized trials included was assessed using the Newcastle-Ottawa scale. Six papers were included in the present systematic review: One non-randomized trial, two case series, and three case reports. Given the literature reported so far, contrast-free and IVUS-guided PCI procedures in patients with CKD appear to be safe (both in cardiac and renal outcomes) with a comparable efficacy to the conventional procedure, even in complex atherosclerotic lesions. No patient included in the mentioned studies showed renal function deterioration and did not need renal replacement therapy after the zero-contrast IVUS-guided percutaneous procedures. From a cardiovascular point of view, this technique proved to be safe in terms of cardiovascular outcomes. The undesirable consequences of conventional PCI in the CKD population might soon be effectively hampered by safer low-to-zero contrast IVUS-guided PCI procedures after a mandatory and rigorous evidence-based validation in long-awaited randomized controlled trials.
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Affiliation(s)
- Alexandru Burlacu
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania; (A.B.); (G.T.)
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (R.C.-D.); (I.V.P.); (A.C.)
- Medical Sciences Academy, 030167 Bucharest, Romania
| | - Grigore Tinica
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania; (A.B.); (G.T.)
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (R.C.-D.); (I.V.P.); (A.C.)
| | - Crischentian Brinza
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania; (A.B.); (G.T.)
- Correspondence: ; Tel.: +40-744488580
| | - Radu Crisan-Dabija
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (R.C.-D.); (I.V.P.); (A.C.)
- Pulmonology Department, Clinic of Pulmonary Diseases, 700115 Iasi, Romania
| | - Iolanda Valentina Popa
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (R.C.-D.); (I.V.P.); (A.C.)
| | - Adrian Covic
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (R.C.-D.); (I.V.P.); (A.C.)
- Medical Sciences Academy, 030167 Bucharest, Romania
- Nephrology Clinic, Dialysis, and Renal Transplant Center, C.I. Parhon” University Hospital, 700503 Iasi, Romania
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Stephan T, Felbel D, Rattka M, Rottbauer W, Markovic S. Impact of radial access on contrast-induced acute kidney injury in patients with coronary artery bypass grafts. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:123-131. [PMID: 33992588 DOI: 10.1016/j.carrev.2021.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 04/24/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We investigated the impact of radial access on contrast-induced acute kidney injury (CI-AKI) in patients with coronary artery bypass graft (CABG) undergoing cardiac catheterization. METHODS This retrospective monocenter study included 527 CABG patients undergoing cardiac catheterization via radial (58.1%, N = 306) or femoral access (41.9%, N = 221). Primary outcome measure was CI-AKI defined in accordance with the KDIGO criteria. Independent predictors for CI-AKI were assessed. 1-year mortality was assessed depending on the occurrence of CI-AKI. RESULTS In total, 99 CABG patients (18.8%) developed CI-AKI within 48 h after cardiac catheterization. Compared to patients without CI-AKI, amount of contrast media used (203.1 ± 102.6 ml vs. 204.2 ± 98.2 ml; P = 0.892) as well as procedural times (87.9 ± 44.8 vs. 79.8 ± 37.0; P = 0.190) were similarly. Regarding vascular access, there was no significant difference in the incidence of CI-AKI between radial and femoral approach (19.0% vs. 18.6%; p = 0.907). However, poor left ventricular ejection fraction (odds ratio [OR] = 1.72, P = 0.026), chronic kidney disease (OR = 2.30, P = 0.001) and acute coronary syndrome (OR = 1.64, P = 0.043) were independent predictors for CI-AKI. The occurrence of CI-AKI was significantly associated with an increased 1-year mortality (hazard ratio [HR] = 2.52, P = 0.003). CONCLUSIONS With 18.8%, CI-AKI is a frequent complication in CABG patients undergoing cardiac catheterization. Radial access did not decrease the risk when compared to the femoral approach.
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Affiliation(s)
- Tilman Stephan
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Dominik Felbel
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Manuel Rattka
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany.
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Kuźma Ł, Małyszko J, Kurasz A, Niwińska MM, Zalewska-Adamiec M, Bachórzewska-Gajewska H, Dobrzycki S. Impact of renal function on patients with acute coronary syndromes: 15,593 patient-years study. Ren Fail 2020; 42:881-889. [PMID: 32862755 PMCID: PMC7472470 DOI: 10.1080/0886022x.2020.1810069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Coexistence of chronic kidney disease (CKD) in the case of acute coronary syndromes (ACS) significantly worsens the outcomes. Aim The aim of our study was to assess renal function impact on mortality among patients with ACS. Materials and methods The study was based on records of 21,985 patients hospitalized in the Medical University of Bialystok in 2009–2015. Inclusion criteria were ACS. Exclusion criteria were: death within 24 h of admission, eGFR <15 ml/min/1.73 m2, hemodialysis. Mean observation time was 2296 days. Results Criteria were met by 2213 patients. CKD occurred in 24.1% (N = 533) and more often affected those with NSTEMI (26.2 (337) vs. 21.2 (196), p = .006). STEMI patients had higher incidence of post-contrast acute kidney injury (PC-AKI) (5 (46) vs. 4.1 (53), p < .001). During the study, 705 people died (31.9%), more often with NSTEMI (33.2% (428) vs. 29.95% (277), p < .001). However, from a group of patients suffering from PC-AKI 57.6% died. The risk of PC-AKI increased with creatinine concentration (RR: 2.990, 95%CI: 1.567–5.721, p < .001), occurrence of diabetes mellitus (RR: 2.143, 95%CI: 1.029–4.463, p = .042), atrial fibrillation (RR: 2.289, 95%CI: 1.056–4.959, p = .036). Risk of death was greater with an increase in postprocedural creatinine concentration (RR: 2.254, 95%CI: 1.481–3.424, p < .001). Conclusion PC-AKI is a major complication in patients with ACS, occurs more frequently in STEMI and may be a prognostic marker of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). More attention should be given to the prevention and diagnosis of PC-AKI but necessary PCI should not be withheld in fear of PC-AKI.
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Affiliation(s)
- Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Jolanta Małyszko
- Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Marta Maria Niwińska
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | | | - Hanna Bachórzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland.,Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
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12
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Gu CH, Wang XZ, Han YL, Jing QM, Ren LL, Zhang Y, Peng JY, Zhao X. Predictors of contrast-induced acute kidney injury in patients with coronary artery disease receiving contrast agents twice within 30 days. Mil Med Res 2020; 7:14. [PMID: 32216841 PMCID: PMC7098087 DOI: 10.1186/s40779-020-00243-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 03/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND None of study mentioned about contrast-induced acute kidney injury (CI-AKI) in people who have received contrast agents twice within in a short period of time. This study is trying to identify the predictors. METHODS We enrolled 607 patients between Oct. 2010 and Jul. 2015 who received contrast agents twice within 30 days in the Department of Cardiology of the General Hospital of Shenyang Military Region. The primary outcome was CI-AKI within 72 h after contrast agent exposure. Patients were divided into groups A (n = 559) and group B (n = 48) according to whether CI-AKI occurred after the second agent. RESULTS Patients in group B (CI-AKI occurred after the second agent) had a more rapid heart rate and more usage of diuretics and digitalis. In group B, CI-AKI occurred more frequently after the first agent. Multivariate logistic regression showed that diuretic (P = 0.006) and intra-aortic balloon pump (IABP) usage (P = 0.012) were independent predictors of CI-AKI after the first agent. Angiotensin-converting enzyme inhibitor/Angiotensin II receptor antagonist (ACEI/ARB) usage (P = 0.039), IABP usage (P = 0.040) and CI-AKI occurring after administration of the first agent (P = 0.015) were independent predictors of CI-AKI after the second. Furthermore, dividing the patients into tertiles of the time interval between the two agents showed that CI-AKI occurred more frequently when the second agent was administered within 1-3 days after the first exposure than within 4-6 days (12.4% vs. 5.0%, P = 0.008) or ≥ 7 days (12.4% vs. 6.4%, P = 0.039). CONCLUSIONS Diuretic and IABP usage are independent predictors of CI-AKI following exposure to a first contrast agent. The major predictors of CI-AKI after exposure to a second agent are time since the first contrast exposure, ACEI/ARB usage, and IABP usage. More importantly, a three-day interval between the two agents is associated with a higher incidence of CI-AKI following the second administration.
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Affiliation(s)
- Chong-Huai Gu
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China.,Department of Cardiovascular, Anqing Municipal Hospital, Anqing, 246000, Anhui, China
| | - Xiao-Zeng Wang
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China
| | - Ya-Ling Han
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China
| | - Quan-Min Jing
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China
| | - Li-Li Ren
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China
| | - Yan Zhang
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China
| | - Jun-Yin Peng
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China
| | - Xin Zhao
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China.
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13
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Kurogi K, Ishii M, Sakamoto K, Komaki S, Marume K, Kusaka H, Yamamoto N, Arima Y, Yamamoto E, Kaikita K, Tsujita K. Persistent Renal Dysfunction in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction. J Am Heart Assoc 2019; 8:e014096. [PMID: 31766973 PMCID: PMC6912980 DOI: 10.1161/jaha.119.014096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The long-term prognosis of patients with acute myocardial infarction who develop persistent renal dysfunction (RD) remains unclear. We investigated risk factors and prognostic implications of persistent RD after contrast-induced nephropathy (CIN) in patients with acute myocardial infarction after primary percutaneous coronary intervention. Methods and Results We enrolled 952 consecutive patients who underwent primary percutaneous coronary intervention for acute myocardial infarction. CIN was defined as an increase in serum creatinine levels ≥0.5 mg/dL or ≥25% from baseline within 72 hours after percutaneous coronary intervention. Persistent RD was defined as residual impairment of renal function over 2 weeks, and transient RD was defined as recovery of renal function within 2 weeks, after CIN. The overall incidence of CIN was 8.8% and that of persistent CIN was 3.1%. A receiver-operator characteristic curve showed that the optimal cutoff value of the contrast volume/baseline estimated glomerular filtration rate ratio for persistent CIN was 3.45. In multivariable logistic analysis, a contrast volume/baseline estimated glomerular filtration rate >3.45 was an independent correlate of persistent RD. At 3 years, the incidence of death was significantly higher in patients with persistent RD than in those with transient RD (P=0.001) and in those without CIN (P<0.001). Cox regression analysis showed that persistent RD (hazard ratio, 4.99; 95% CI, 2.30-10.8; P<0.001) was a significant risk factor for mortality. A similar trend was observed for the combined end points, which included mortality, hemodialysis, stroke, and acute myocardial infarction. Conclusions Persistent RD, but not transient RD, is independently associated with long-term mortality. A contrast volume/baseline estimated glomerular filtration rate >3.45 is an independent predictor of persistent RD.
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Affiliation(s)
- Kazumasa Kurogi
- Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki Japan
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Soichi Komaki
- Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki Japan
| | - Kyohei Marume
- Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki Japan
| | - Hiroaki Kusaka
- Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki Japan
| | - Nobuyasu Yamamoto
- Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
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Prevalence and Predictors of Contrast-Induced Nephropathy (CIN) in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Percutaneous Coronary Intervention (PCI): A Meta-Analysis. J Interv Cardiol 2019; 2019:2750173. [PMID: 31772520 PMCID: PMC6854223 DOI: 10.1155/2019/2750173] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/10/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022] Open
Abstract
Background Contrast-induced nephropathy (CIN) becomes more and more frequent after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). There have been no reported meta-analyses to determine the role of these risk factors in predicting CIN in patients with STEMI undergoing PCI. So we made this meta-analysis to summarize the incidence of CIN in patients with STEMI undergoing PCI and to study associations between CIN and several risk factors that are mentioned in most prevention guidelines. Hypothesis The overall incidence of CIN in patients with STEMI undergoing PCI is not low. Many risk factors could influence the occurrence of CIN, such as hypertension, diabetes mellitus (DM), and lower estimated glomerular filtration rate. Methods Databases, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Chinese BioMedical (CBM), were searched for articles published before May 21, 2019, to identify all relevant studies on CIN. The pooled data were analyzed using either fixed-effects or random-effects models depending on heterogeneity (assessed via the I 2 index). Results Twelve articles encompassing a total of 6342 patients were included. The overall pooled CIN incidence was 13.3% (95% CI: 10.4-17.1). The forest plots showed positive associations between CIN and the presence of hypertension, diabetes mellitus, history of prior myocardial infarction, age, damaged left anterior descending artery, Killip class ≥2, decreased left ventricular ejection fraction, lower estimated glomerular filtration rate, and left ventricular ejection fraction <40%; the odds ratios for these factors were 1.85 (95% CI: 1.57-2.18; p < 0.00001), 1.83 (95% CI: 1.47-2.29; p < 0.00001), 2.14 (95% CI: 1.46-3.14; p < 0.0001), 7.79 (95% CI: 5.24-10.34; p < 0.00001), 1.92 (95% CI: 1.15-3.22; p=0.01), 3.12 (95% CI: 2.21-4.40; p < 0.00001), -6.15 (95% CI: -9.52 to -2.79; p=0.0003), -15.06 (95% CI: -24.75 to -5.36; p=0.002), and 5.53 (95% CI: 1.10-27.95; p=0.04), respectively. Conclusion The overall incidence of CIN in patients with STEMI undergoing PCI was not low and was closely associated with hypertension, diabetes mellitus, history of prior myocardial infarction, age, damaged left anterior descending artery, Killip class ≥2, decreased left ventricular ejection fraction, lower estimated glomerular filtration rate, and left ventricular ejection fraction <40%.
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15
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Yildiz I, Yildiz PO, Rencuzogullari I, Karabag Y, Cagdas M, Burak C, Gurevin MS. Association of Serum Osmolarity With Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction. Angiology 2019; 70:627-632. [DOI: 10.1177/0003319719826466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Contrast-induced nephropathy (CIN) is a prevalent and serious complication after primary percutaneous coronary intervention (pPCI). Although the association between serum osmolarity and chronic kidney disease is well established, its relation to CIN in patients with ST-segment elevation myocardial infarction (STEMI) undergoing pPCI needs to be elucidated. We evaluated the predictive value of serum osmolarity for CIN development in patients with STEMI (n = 768) undergoing pPCI. Serum osmolarity on admission was calculated. The study population was divided into 2 groups according to CIN development, and both groups were compared according to clinical, laboratory, and demographic features, including the serum osmolarity. Serum osmolarity was significantly higher in patients with CIN than in those without CIN (278 [8] vs 284 [9]; P = .024). Serum osmolarity (odds ratio: 1.052; 95% confidence interval: 1.018-1.086; P = .002), hemoglobin, contrast media volume, creatinine on admission, basal SYNergy between PCI with TAXus and cardiac surgery II score, and left ventricular ejection fraction were found to be independent predictors of CIN. Serum osmolarity (given the simple calculation of this parameter on admission) can be useful to define patients with STEMI undergoing pPCI who are more likely to develop CIN.
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Affiliation(s)
- Ibrahim Yildiz
- Department of Cardiology, Osmaniye State Hospital, Osmaniye, Turkey
| | | | | | - Yavuz Karabag
- Department of Cardiology, Kafkas University Medical Faculty, Kars, Turkey
| | - Metin Cagdas
- Department of Cardiology, Kafkas University Medical Faculty, Kars, Turkey
| | - Cengiz Burak
- Department of Cardiology, Kafkas University Medical Faculty, Kars, Turkey
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16
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Yang Y, George KC, Luo R, Cheng Y, Shang W, Ge S, Xu G. Contrast-induced acute kidney injury and adverse clinical outcomes risk in acute coronary syndrome patients undergoing percutaneous coronary intervention: a meta-analysis. BMC Nephrol 2018; 19:374. [PMID: 30577763 PMCID: PMC6303898 DOI: 10.1186/s12882-018-1161-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 11/28/2018] [Indexed: 01/20/2023] Open
Abstract
Background Recent studies have shown associations between contrast-induced acute kidney injury (CI-AKI) and increased risk of adverse clinical outcomes in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI); however, the estimates are inconsistent and vary widely. Therefore, this meta-analysis aimed to evaluate the precise associations between CI-AKI and adverse clinical consequences in patients undergoing PCI for ACS. Methods EMBASE, PubMed, Web of Science™ and Cochrane Library databases were systematically searched from inception to December 16, 2016 for cohort studies assessing the association between CI-AKI and any adverse clinical outcomes in ACS patients treated with PCI. The results were demonstrated as pooled risk ratios (RRs) with 95% confidence intervals (CI). Heterogeneity was explored by subgroup analyses. Results We identified 1857 articles in electronic search, of which 22 (n = 32,781) were included. Our meta-analysis revealed that in ACS patients undergoing PCI, CI-AKI significantly increased the risk of adverse clinical outcomes including all-cause mortality (18 studies; n = 28,367; RR = 3.16, 95% CI 2.52–3.97; I2 = 56.9%), short-term all-cause mortality (9 studies; n = 13,895; RR = 5.55, 95% CI 3.53–8.73; I2 = 60.1%), major adverse cardiac events (7 studies; n = 19,841; RR = 1.49, 95% CI: 1.34–1.65; I2 = 0), major adverse cardiovascular and cerebrovascular events (3 studies; n = 2768; RR = 1.86, 95% CI: 1.42–2.43; I2 = 0) and stent restenosis (3 studies; n = 130,678; RR = 1.50, 95% CI: 1.24–1.81; I2 = 0), respectively. Subgroup analyses revealed that the studies with prospective cohort design, larger sample size and lower prevalence of CI-AKI might have higher short-term all-cause mortality risk. Conclusions CI-AKI may be a prognostic marker of adverse outcomes in ACS patients undergoing PCI. More attention should be paid to the diagnosis and management of CI-AKI. Electronic supplementary material The online version of this article (10.1186/s12882-018-1161-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yi Yang
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Kaisha C George
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Ran Luo
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Yichun Cheng
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Weifeng Shang
- Department of Nephrology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430000, People's Republic of China
| | - Shuwang Ge
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China.
| | - Gang Xu
- Department of Nephrology, Tongji Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, Hubei, 430030, People's Republic of China
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17
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Pickering JW, Blunt IRH, Than MP. Acute Kidney Injury and mortality prognosis in Acute Coronary Syndrome patients: A meta-analysis. Nephrology (Carlton) 2018; 23:237-246. [PMID: 27990707 DOI: 10.1111/nep.12984] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 01/06/2023]
Abstract
AIM The aim of this study is to provide a robust estimate of mortality risk in acute coronary syndrome (ACS)-associated acute kidney injury (AKI) to inform clinical practice and policy. METHODS A meta-analysis of cohort studies evaluating outcomes of ACS and which reported AKI and AKI-associated mortality. Studies were excluded if they incorporated patients not admitted through the emergency department (i.e. for elective procedures), were limited to cardiogenic shock or cardiac arrest, or relied on registry data for outcomes without further adjudication. The predictor was ACS-associated AKI and outcomes early (30 day or in-hospital) mortality and late-mortality (post-hospital discharge). RESULTS Thirty-six studies with 37 unique cohorts comprising 100 476 patients were included. The pooled rate of ACS-associated AKI was 15.8%. In 32 cohorts reporting early mortality, the crude early mortality rate was 15.0% amongst those with AKI compared with 2.0% amongst those without AKI. The pooled estimate of the relative risk of AKI-associated early mortality was 4.1 (95% confidence interval: 3.3 to 5.0) with high heterogeneity between studies (I 2 = 84% (61% to 88%)). When heterogeneity was accounted for mathematically using credibility ceilings, the risk of mortality was lower, but still clinically significant (3.1 (2.6 to 3.6)). In 19 cohorts reporting late mortality (1 to 10 years), the relative risk of AKI-associated mortality was 2.6 (2.0 to 3.3) with moderate heterogeneity (I 2 = 65 % [35% to 88%]). Following application of credibility ceiling relative risk estimate dropped to 2.2 (1.9 to 2.6). CONCLUSIONS Acute coronary syndrome-associated AKI is associated with more than a three-fold increase in early mortality and more than two-fold in long-term mortality.
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Affiliation(s)
- John W Pickering
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.,Emergency Department, Christchurch hospital, Christchurch, New Zealand
| | | | - Martin P Than
- Emergency Department, Christchurch hospital, Christchurch, New Zealand
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18
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Sinert R. Acute Kidney Injury: Who Should be Followed-up and by Whom? Acad Emerg Med 2018; 25:807-810. [PMID: 29360248 DOI: 10.1111/acem.13378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Richard Sinert
- Department of Emergency Medicine, SUNY-Downstate Medical Center, Kings County Hospital, New York City Health & Hospitals, Brooklyn, NY
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Amiri A, Ghanavati R, Riahi Beni H, Sezavar SH, Sheykhvatan M, Arab M. Metabolic Syndrome and the Iodine-Dose/Creatinine Clearance Ratio as Determinants of Contrast-Induced Acute Kidney Injury. Cardiorenal Med 2018; 8:217-227. [PMID: 29909417 DOI: 10.1159/000488374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/17/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Finding patients at risk of developing contrast-induced acute kidney injury (CI-AKI) is important because of its associated complications. In the present study, the contribution of different variables, such as the presence of metabolic syndrome (MetS), the volume creatinine clearance (V/CrCl) ratio, the iodine-dose (I-dose)/CrCl ratio, or hypertension, to CI-AKI was evaluated. METHODS A total of 255 patients undergoing elective coronary angiography with or without intervention were enrolled and divided into a MetS and a control group. All patients were assessed for the development of CI-AKI after the procedures. RESULTS CI-AKI occurred in 39.23% (51 of 130) of the MetS patients and 14.4% (18 of 125) of the control group (p < 0.001). The multivariable regression model showed that male sex and the use of statins decreased the risk of CI-AKI, and high triglyceride levels, I-dose/CrCl > 0.52, MetS, CrCl ≤60 mL/min, and age ≥70 years increased the risk of CI-AKI, independent of confounding factors. The difference in the mean V/CrCl ratio was statistically significant between patients who developed CI-AKI and those who did not show renal impairment (2.36 ± 1.35 vs. 1.43 ± 0.89, respectively; p < 0.001). The ROC curve analysis of I-dose/CrCl determined the best cutoff value for patients with and those without MetS as 0.51 and 0.63, with a sensitivity value of 68 and 72% and a specificity value of 73 and 74%, respectively. CONCLUSIONS We showed that MetS is a strong risk factor for CI-AKI in nondiabetic patients undergoing elective coronary interventions; and the I-dose/CrCl ratio is a strong predictor of CI-AKI in these patients. We suggest that clinicians identify MetS patients and calculate their I-dose/CrCl ratio before coronary interventions.
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Affiliation(s)
- Ali Amiri
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Ghanavati
- Department of Cardiovascular Medicine, Rasoul-e-Akram General Hospital, IUMS, Tehran, Iran
| | - Hassan Riahi Beni
- Department of Cardiovascular Medicine, Rasoul-e-Akram General Hospital, IUMS, Tehran, Iran
| | - Seyyed Hashem Sezavar
- Department of Cardiovascular Medicine, Rasoul-e-Akram General Hospital, IUMS, Tehran, Iran
| | - Mehrdad Sheykhvatan
- Department of Cardiovascular Medicine, Rasoul-e-Akram General Hospital, IUMS, Tehran, Iran
| | - Mahsa Arab
- Department of Cardiovascular Medicine, Rasoul-e-Akram General Hospital, IUMS, Tehran, Iran
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Feldkamp T, Luedemann M, Spehlmann ME, Freitag-Wolf S, Gaensbacher J, Schulte K, Bajrovic A, Hinzmann D, Hippe HJ, Kunzendorf U, Frey N, Luedde M. Radial access protects from contrast media induced nephropathy after cardiac catheterization procedures. Clin Res Cardiol 2017; 107:148-157. [PMID: 28939956 DOI: 10.1007/s00392-017-1166-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 09/19/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess, whether cardiac catheterization via radial access prevents contrast-induced nephropathy. BACKGROUND Contrast-induced nephropathy (CIN) is a major clinical problem which accounts for more than 10% of acute kidney injury cases in hospitalized patients. Protective measures such as the infusion of isotonic saline solution or acetylcysteine have not consistently been proven to prevent acute kidney injury (AKI). However, there is growing evidence that radial access for coronary angiography and coronary intervention is associated with a lower incidence of AKI compared to femoral access. METHODS AND RESULTS In a retrospective monocentric analysis, 2937 patients that had undergone cardiac catheterization were examined. Up to 2013, coronary intervention was performed primarily via the femoral artery in our hospital; thereafter, interventions were primarily done via the radial artery. In the cohort under study, 1141 patients had received catheterization using the radial access while 1796 were examined via the femoral artery. No significant differences were found in the two groups regarding the amount of iodinated contrast medium applied [femoral group: 180 (120-260) ml; radial group: 180 (120-250) ml; P = 0.438]. A total of 400 (13.6%) patients developed acute kidney injury (AKI) after cardiac catheterization (85.3% AKI stage 1; 12.8% AKI stage 2; 2% AKI stage 3). AKI was significantly less frequent in patients that had received radial access compared to patients with femoral access (10.1 vs. 15.9%, P < 0.001). Multivariate regression analysis showed that patient age (1.03/year; 95% CI 1.02-1.04/year; P < 0.001), the amount of contrast media applied (OR 1.003/ml; 95% CI 1.002-1.004/ml; P < 0.001), acute coronary syndrome (OR 2.01, 95% CI 1.52-2.66; P < 0.001), CKD (OR 1.62, 95% CI 1.50-1.70; P < 0.001), pre-existing heart failure (OR 1.27, 95% CI 1.00-1.42 P = 0.007), previous myocardial infarction (OR 1.34, 95% CI 1.15-1.49; P = 0.001), diabetes (OR 1.25, 95% CI 1.04-1.41; P = 0.020) and serum creatinine before the procedure (1.45/mg/dl; 95% CI 1.24-1.69/mg/dl; P < 0.001) were important risk factors for the occurrence of AKI. Our analysis points to a significant risk reduction using radial access (OR 0.65; 95% CI 0.51-0.83; P < 0.001). Interestingly, this reduction in risk was also evident in patients with CKD (OR 0.59; 95% CI 0.41-0.87; P = 0.007). The superiority of radial access was particularly obvious in the subgroup of patients with acute coronary syndrome (13.1% AKI in the radial access group vs. 23.6% AKI in the femoral access group, OR 0.52; 95% CI 0.34-0.81; P = 0.003). CONCLUSION Our study shows that cardiac catheterization using radial access bears significantly lower risk of AKI than cardiac catheterization via femoral access. The advantage of radial access in acute coronary syndrome regarding morbidity and mortality could partly be explained by the here demonstrated reduced risk for AKI. Thus, radial access should be preferred in patients at risk for AKI.
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Affiliation(s)
- Thorsten Feldkamp
- Internal Medicine IV, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Maya Luedemann
- Internal Medicine III, University Hospital of Schleswig Holstein, Campus Kiel, Rosalind-Franklin-Str.12, 24105, Kiel, Germany
| | - Martina E Spehlmann
- Internal Medicine III, University Hospital of Schleswig Holstein, Campus Kiel, Rosalind-Franklin-Str.12, 24105, Kiel, Germany
| | - Sandra Freitag-Wolf
- Institute for Medical Information Technology and Statistics, Christian Albrechts University Kiel, Kiel, Germany
| | - Julia Gaensbacher
- Internal Medicine III, University Hospital of Schleswig Holstein, Campus Kiel, Rosalind-Franklin-Str.12, 24105, Kiel, Germany
| | - Kevin Schulte
- Internal Medicine IV, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Amer Bajrovic
- Internal Medicine III, University Hospital of Schleswig Holstein, Campus Kiel, Rosalind-Franklin-Str.12, 24105, Kiel, Germany
| | - Dieter Hinzmann
- Internal Medicine III, University Hospital of Schleswig Holstein, Campus Kiel, Rosalind-Franklin-Str.12, 24105, Kiel, Germany
| | - Hans-Joerg Hippe
- Internal Medicine III, University Hospital of Schleswig Holstein, Campus Kiel, Rosalind-Franklin-Str.12, 24105, Kiel, Germany
| | - Ulrich Kunzendorf
- Internal Medicine IV, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Norbert Frey
- Internal Medicine III, University Hospital of Schleswig Holstein, Campus Kiel, Rosalind-Franklin-Str.12, 24105, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Mark Luedde
- Internal Medicine III, University Hospital of Schleswig Holstein, Campus Kiel, Rosalind-Franklin-Str.12, 24105, Kiel, Germany.
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Schmucker J, Fach A, Becker M, Seide S, Bünger S, Zabrocki R, Fiehn E, Würmann-Busch B, Pohlabeln H, Günther K, Ahrens W, Hambrecht R, Wienbergen H. Predictors of acute kidney injury in patients admitted with ST-elevation myocardial infarction - results from the Bremen STEMI-Registry. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:710-722. [PMID: 29064276 DOI: 10.1177/2048872617708975] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND: Deterioration of renal function after exposition to contrast media is a common problem in patients with myocardial infarction undergoing percutaneous coronary interventions. The aim of the present study was to assess the incidence of acute kidney injury in patients admitted with ST-elevation-myocardial infarction (STEMI) and its association with infarction severity, comorbidities and treatment modalities, including amount of contrast media applied. METHODS: All patients with STEMI from the metropolitan area of Bremen, Germany are treated at the Bremen Heart Centre and since 2006 documented in the Bremen STEMI-Registry. Acute kidney injury was graded from stage 0 to 3 following the Kidney-disease-improving-global outcomes criteria from 2012. RESULTS: Data from 3810 patients admitted with STEMI were included in this study. No acute kidney injury was observed in 3120 (82%) patients while acute kidney injury was detected in 690 (18%) patients: Stage 1: n=497 (13%), 2: n=66 (2%), 3: n=127 (3%). Acute kidney injury was associated with elevated 30-day (0: 3%, 1: 20%, 2: 46%, 3: 58%) and one-year mortality rates (0: 6%, 1: 26%, 2: 49%, 3: 66%). Higher acute kidney injury stages were associated with higher peak creatine kinase (in U/l±SEM): stage 0: 1748±33, 1: 2588±127, 2: 3684±395, 3: 3330±399, p (<0.01), lower mean systolic blood pressure at admission (in mmHG±SD): 0: 133±28, 1: 129±31; 2: 121±31, 3: 115±33 ( p<0.01) and higher Thrombolysis in Myocardial Infarction risk score for STEMI (scale 0-14±SD): 0: 2.71±2, 1: 4.08±2, 2: 4.98±2, 3: 5.05±2, ( p<0.01). However, no such association could be found between acute kidney injury stage and amount of contrast media applied (in ml±SD) 0: 138±57, 1: 139±61; 2: 140±76; 3: 145±80 ( p=0.5). Reduced initial glomerular filtration rate was associated with higher incidences of acute kidney injury while again no relation to amount of contrast media could be observed in subgroups ranked by initial glomerular filtration rate. A multivariate analysis confirmed these results: while left-heart-failure/cardiogenic shock (odds ratio (OR) 4.2, 95% confidence interval (CI) 3.3-5.5) as well as larger infarctions (peak creatine kinase >3000 U/l (OR 2.2, 95% CI 1.7-2.8)) were independently associated with a greater risk for acute kidney injury, amount of contrast media applied during angiography was not (150-250 ml, OR 0.95, 95% CI 0.8-1.2 ( p=0.7), >250 ml, OR 1.3, 95% CI 0.8-2.0 ( p=0.5)). CONCLUSIONS: Acute kidney injury, which was associated with elevated short- and long-term mortality rates, could be observed in 18% of patients admitted with STEMI. The present data suggest that severity and haemodynamic impairment due to STEMI rather than contrast-media-induced nephropathy is the key contributor for acute kidney injury in STEMI patients. The deleterious effect of the myocardial infarction itself on renal function can be explained through renal hypoperfusion, neurohormonal activation or other pathomechanisms that might have been underestimated in the past.
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Affiliation(s)
- Johannes Schmucker
- 1 The Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen, Germany
| | - Andreas Fach
- 1 The Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen, Germany
| | | | - Susanne Seide
- 1 The Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen, Germany
| | - Stefanie Bünger
- 1 The Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen, Germany
| | - Robert Zabrocki
- 1 The Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen, Germany
| | - Eduard Fiehn
- 1 The Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen, Germany
| | - Bettina Würmann-Busch
- 1 The Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen, Germany
| | - Hermann Pohlabeln
- 3 Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen, Germany
| | - Kathrin Günther
- 3 Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen, Germany
| | - Wolfgang Ahrens
- 3 Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen, Germany
| | - Rainer Hambrecht
- 1 The Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen, Germany
| | - Harm Wienbergen
- 1 The Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen, Germany
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Lian D, Liu Y, Liu YH, Li HL, Duan CY, Yu DQ. Pre-Procedural Risk Score of Contrast-Induced Nephropathy in Elderly Patients Undergoing Elective Coronary Angiography. Int Heart J 2017; 58:197-204. [PMID: 28320991 DOI: 10.1536/ihj.16-129] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To establish a scoring model to predict the risk of contrast-induced nephropathy (CIN) in elderly patients undergoing elective coronary angiography (CAG).A total of 1286 patients aged > 65 years who had undergone elective CAG between August 2009 and February 2013 were enrolled in this study. They were randomly (3:2) assigned to a development (n = 756) or validation dataset (n = 530). Independent predictors of CIN were identified by using logistic regression and were assigned a weighted integer, which was used to establish a score model.CIN incidence in the development set was 6.3%. The risk score model contained 3 variables (with the weighted integer): age > 75 years (1.5), creatinine clearance (CrCl) < 60 mL/minute (1), and congestive heart failure (CHF) (1.5). CIN incidence was 3.1%, 9.1%, and 29.0% in the low-risk group (≤ 1), moderate risk group (1 - 3), and high-risk group (≥ 3), respectively. The risk model demonstrated good prediction value in the development (c-statistic = 0.727) and validation (c-statistic = 0.695) datasets. Compared to the non-CIN group, the CIN group had a significantly higher rate of inhospital major adverse cardiac events (P < 0.01).The risk score model with 3 variables, namely age > 75 years, CrCl < 60 mL/minute, and CHF, is a clinical prediction tool for CIN in elderly patients before elective CAG. CIN is one of the independent risk factors of major adverse cardiac events (MACE).
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Affiliation(s)
- Dan Lian
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital
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Abstract
Contrast-induced acute kidney injury (CI-AKI) is defined as an abrupt deterioration in renal function associated with the administration of iodinated contrast media. This type of acute kidney injury is frequently encountered as a complication of percutaneous coronary intervention (PCI) and is associated with adverse short- and long-term outcomes including mainly mortality, cardiovascular morbidity and prolongation of hospitalization. The incidence of CI-AKI after PCI ranges from 2 to 20 % according to baseline kidney function. It may also range according to the clinical setting, being higher after emergency PCI. The primary manifestation is a small decline in kidney function, occurring 1 to 3 days after the procedure. Kidney function usually returns to preexisting levels within 7 days. Incidence of acute renal failure requiring dialysis following PCI is rare (<1 %). The present article aims to review up-to-date published data concerning diagnosis, definition, epidemiology and prognosis of this novel in-hospital epidemic.
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Affiliation(s)
- George Chalikias
- University Cardiology Department, Medical School, Democritus University of Thrace, Dragana, GR-68131, Alexandroupolis, Greece
| | - Ioannis Drosos
- University Cardiology Department, Medical School, Democritus University of Thrace, Dragana, GR-68131, Alexandroupolis, Greece
| | - Dimitrios N Tziakas
- University Cardiology Department, Medical School, Democritus University of Thrace, Dragana, GR-68131, Alexandroupolis, Greece.
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Incidence of Contrast-Induced Nephropathy After Renal Graft Catheter Arteriography Using Iodine-Based Contrast Medium. AJR Am J Roentgenol 2016; 206:783-6. [PMID: 26866337 DOI: 10.2214/ajr.15.15501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of our study was to assess the incidence of contrast-induced nephropathy (CIN), dialysis, and graft loss after direct intraarterial infusion of iodine-based contrast medium (CM) in renal allograft recipients. MATERIALS AND METHODS One hundred patients underwent renal graft catheter arteriography between 2006 and 2014. CIN was defined as an increase in serum creatinine value of 0.5 mg/dL or more above the creatinine value before arteriography. CIN could be assessed in 37 patients with creatinine levels obtained before arteriography and 24-72 hours after arteriography. Dialysis requirement and renal allograft loss at 30 days after the procedure were recorded in all 100 patients. RESULTS In the 37 patients who could be assessed for CIN, three patients (8%) met the criteria for CIN. In a subgroup analysis, there was an increased incidence of CIN in patients undergoing angiography alone (25%) compared with those in the angioplasty and stenting group (0%) (p = 0.028). At 30 days after the procedure, none (0/100) of the patients required dialysis or had graft failure. CONCLUSION In a cohort of patients with a single renal allograft undergoing renal graft catheter arteriography using iodine-based CM, the overall incidence of CIN was low and no major adverse outcomes were noted at 30 days after the procedure. However, in a subgroup analysis, the patients who underwent arteriography alone-that is, without angioplasty or stenting-had a statistically significant higher rate of CIN.
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Farhan S, Vogel B, Tentzeris I, Jarai R, Freynhofer MK, Smetana P, Egger F, Kautzky-Willer A, Huber K. Contrast induced acute kidney injury in acute coronary syndrome patients: A single centre experience. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:55-61. [DOI: 10.1177/2048872615574707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/04/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Serdar Farhan
- Third Department of Medicine, Cardiology, Wilhelminen Hospital, Austria
| | - Birgit Vogel
- Third Department of Medicine, Cardiology, Wilhelminen Hospital, Austria
| | - Ioannis Tentzeris
- Third Department of Medicine, Cardiology, Wilhelminen Hospital, Austria
| | - Rudolf Jarai
- Third Department of Medicine, Cardiology, Wilhelminen Hospital, Austria
| | | | - Peter Smetana
- Third Department of Medicine, Cardiology, Wilhelminen Hospital, Austria
| | - Florian Egger
- Third Department of Medicine, Cardiology, Wilhelminen Hospital, Austria
| | - Alexandra Kautzky-Willer
- 3rd Department of Medicine, Division of Endocrinology and Metabolism, Medical University Vienna, Austria
| | - Kurt Huber
- Third Department of Medicine, Cardiology, Wilhelminen Hospital, Austria
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Manari A, Magnavacchi P, Puggioni E, Vignali L, Fiaccadori E, Menozzi M, Tondi S, Robotti S, Ferrari D, Valgimigli M. Acute kidney injury after primary angioplasty: effect of different hydration treatments. J Cardiovasc Med (Hagerstown) 2014; 15:60-7. [PMID: 24500238 DOI: 10.2459/jcm.0b013e3283641bb8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS We evaluated the effect of different dose hydration protocols, with normal saline or bicarbonate, on the incidence of contrast-induced acute kidney injury (CI-AKI) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). METHODS We considered 592 STEMI patients treated with PPCI in 5 Italian centers. Patients were randomized to receive standard or high-dose infusions of normal saline or sodium bicarbonate started immediately before contrast medium administration and continued for the following 12 h. RESULTS The cumulative incidence of CI-AKI was 18.1% without any difference among treatment groups. Shock, age, ejection fraction 35% or less, and basal serum creatinine were significantly associated with an increased risk of CI-AKI. Follow-up at 12 months was complete in 573 patients. Overall, 25 out of 573 patients died (4.3%). We observed higher short-term mortality rates in patients receiving high-volume hydration. Otherwise, only age, shock and CI-AKI were significantly associated with 1-year mortality. CONCLUSION In patients with STEMI undergoing PPCI, high-volume hydration with normal saline or sodium bicarbonate administrated at the time of contrast media administration was not associated with any significant advantage in terms of CI-AKI prevention.
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Affiliation(s)
- Antonio Manari
- aCardiologia Interventistica Azienda Ospedaliera-IRCCS S. Maria Nuova, Reggio Emilia bCardiologia, Nuovo Ospedale Civile S. Agostino-Estense, Modena cDipartimento di Cardiologia, Ospedali del Tigullio, Lavagna dDivisione di Cardiologia, Ospedale Maggiore, Parma eDivisione di Nefrologia, Dipartimento di Medicina Interna, Università di Parma fIBIS Informatica, Milan gIstituto di Cardiologia, Azienda Ospedaliera-Universitaria S. Anna, Ferrara, Italy
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Prasad V, Gandhi D, Stokum C, Miller T, Jindal G. Incidence of contrast material-induced nephropathy after neuroendovascular procedures. Radiology 2014; 273:853-8. [PMID: 25102293 DOI: 10.1148/radiol.14131104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To report the incidence and risk factors for contrast material ( CM contrast material )-induced nephropathy ( CIN CM-induced nephropathy ) in patients with no history of chronic kidney disease and estimated glomerular filtration rate that exceeded 30 mL/min/1.73 m(2) after a relatively high dose of CM contrast material (≥250 mL) during neuroendovascular procedures. MATERIALS AND METHODS An institutional review board-approved retrospective chart review was performed for all patients who received a dose of CM contrast material 250 mL or greater while they underwent a neuroendovascular procedure between January 2011 and February 2013. The control group consisted of comparable patients who received a CM contrast material dose of 75-249 mL during the same period. Patients with pre-existing estimated glomerular filtration rate of 30 mL/min/1.73 m(2) or less or documented history of chronic kidney disease were excluded. CIN CM-induced nephropathy was defined as an increase in serum creatinine 50% above the baseline or an absolute increase of 0.3 mg/dL at either 24 or 48 hours after the procedure. Statistical analysis was performed with the Student t test, χ(2) analysis, and mixed-model analysis of variance. RESULTS Clinical characteristics between the control and high-dose group were similar for age (95% confidence interval [CI]: -3.69, 5.48; P = .70), sex (95% CI: 0.28, 0.43; P = .62), and ethnicity (95% CI: 0.42, 0.58; P = .47). The average volume of CM contrast material administered was 172 mL in the control group and 326 mL in the high-dose cohort (95% CI: 131.78, 175.05; P < .001). Of the 79 cases in the high-dose cohort, 36 (46%) received a CM contrast material dose between 250 and 299 mL, 29 (37%) received 300-399 mL, nine (11%) received 400-499 mL, and five (6%) received greater than 500 mL. By 48 hours, a statistically significant decrease in serum creatinine was seen in two of the four high-dose CM contrast material dose categories: 250-299 mL (decrease of 24%; [95% CI: 0.04, 0.36]; P = .003) and greater than 500 mL (decrease of 14% [95% CI: -0.33, 0.57]; P = .007). There were four cases (5%) of CIN CM-induced nephropathy : three (4%) at 24 hours and one (1%) at 48 hours. The comorbid rate of diabetes (25% vs 15% [95% CI: -0.01, 0.04]; P < .001) was found to be higher among those who developed CIN CM-induced nephropathy compared with those who did not within the high-dose cohort. No cases of CIN CM-induced nephropathy occurred in the control group. CONCLUSION Risk of developing CIN CM-induced nephropathy is relatively low in patients who undergo neuroendovascular procedures with CM contrast material doses of 250 mL or greater.
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Affiliation(s)
- Vikram Prasad
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Interventional Neuroradiology, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201
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Shaw C, Nitsch D, Steenkamp R, Junghans C, Shah S, O’Donoghue D, Fogarty D, Weston C, Sharpe CC. Inpatient coronary angiography and revascularisation following non-ST-elevation acute coronary syndrome in patients with renal impairment: a cohort study using the Myocardial Ischaemia National Audit Project. PLoS One 2014; 9:e99925. [PMID: 24937680 PMCID: PMC4061061 DOI: 10.1371/journal.pone.0099925] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 05/20/2014] [Indexed: 11/18/2022] Open
Abstract
Background International guidelines support an early invasive management strategy (including early coronary angiography and revascularisation) for non-ST-elevation acute coronary syndrome (NSTE-ACS) in patients with renal impairment. However, evidence from outside the UK suggests that this approach is underutilised. We aimed to describe practice within the NHS, and to determine whether the severity of renal dysfunction influenced the provision of angiography and modified the association between early revascularisation and survival. Methods We performed a cohort study, using multivariable logistic regression and propensity score analyses, of data from the Myocardial Ischaemia National Audit Project for patients presenting with NSTE-ACS to English or Welsh hospitals between 2008 and 2010. Findings Of 35 881 patients diagnosed with NSTE-ACS, eGFR of <60 ml/minute/1.73 m2 was present in 15 680 (43.7%). There was a stepwise decline in the odds of undergoing inpatient angiography with worsening renal dysfunction. Compared with an eGFR>90 ml/minute/1.73 m2, patients with an eGFR between 45–59 ml/minute/1.73 m2 were 33% less likely to undergo angiography (adjusted OR 0.67, 95% CI 0.55–0.81); those with an eGFR<30/minute/1.73 m2 had a 64% reduction in odds of undergoing angiography (adjusted OR 0.36, 95%CI 0.29–0.43). Of 16 646 patients who had inpatient coronary angiography, 58.5% underwent inpatient revascularisation. After adjusting for co-variables, inpatient revascularisation was associated with approximately a 30% reduction in death within 1 year compared with those managed medically after coronary angiography (adjusted OR 0.66, 95%CI 0.57–0.77), with no evidence of modification by renal function (p interaction = 0.744). Interpretation Early revascularisation may offer a similar survival benefit in patients with and without renal dysfunction, yet renal impairment is an important determinant of the provision of coronary angiography following NSTE-ACS. A randomised controlled trial is needed to evaluate the efficacy of an early invasive approach in patients with severe renal dysfunction to ensure that all patients who may benefit are offered this treatment option.
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Affiliation(s)
- Catriona Shaw
- UK Renal Registry, Southmead Hospital, Bristol, United Kingdom
- Department of Renal Sciences, Division of Transplantation Immunology and Mucosal Biology, Kings College London, London, United Kingdom
- * E-mail:
| | - Dorothea Nitsch
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Retha Steenkamp
- UK Renal Registry, Southmead Hospital, Bristol, United Kingdom
| | - Cornelia Junghans
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Sapna Shah
- Department of Renal Medicine, Kings College Hospital, London, United Kingdom
| | - Donal O’Donoghue
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Damian Fogarty
- Department of Renal Medicine, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Clive Weston
- Myocardial Ischaemia National Audit Project, College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Claire C. Sharpe
- Department of Renal Sciences, Division of Transplantation Immunology and Mucosal Biology, Kings College London, London, United Kingdom
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Ugur M, Uluganyan M, Ekmekci A, Bozbay M, Karaca G, Cicek G, Koroglu B, Tusun E, Murat A, Turan B, Uyarel H, Orhan AL, Eren M. Combination of hemoglobin and left ventricular ejection fraction as a new predictor of contrast induced nephropathy in patients with non-ST elevation myocardial infarction. Med Sci Monit 2014; 20:967-73. [PMID: 24920294 PMCID: PMC4067426 DOI: 10.12659/msm.890096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/24/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hemoglobin concentration (Hb) and left ventricular ejection fraction (EF) are known predictors of contrast induced nephropathy (CIN). We hypothesized that combination of Hb concentration and left ventricular EF is superior to either variable alone in predicting contrast induced nephropathy in patients with acute coronary syndrome (ACS). MATERIAL AND METHODS Consecutive patients with ACS were prospectively enrolled. Patients considered for invasive strategy were included. Baseline creatinine levels were detected on admission and 24, 48 and 72 hours after coronary intervention. 25% or 0,5 umol/L increase in creatinine level was considered as CIN. RESULTS 268 patients with ACS (mean age 58±11 years, 77% male) were enrolled. Contrast induced nephropathy was observed in 26 (9.7%) of patients. Baseline creatinine concentration, left ventricular EF, and Hemoglobin was significantly different between two groups. Contrast volume to estimated glomerular filtration rate ratio (OR: 1.310, 95% CI: 1.077-1.593, p=0.007) and the combination of Hb and left ventricular EF (OR: 0.996, 95% CI: 0.994-0.998, p=0.001) were found to be independent predictors for CIN. Hb × LVEF ≤690 had 85% sensitivity and 57% specificity to predict CIN (area under curve: 0.724, 95% CI: 0.625-0.824, p<0.001). In addition, Hb × LVEF ≤690 had a negative predictive value of 97% in our analysis CONCLUSIONS The combination of Hb and left ventricular EF is better than either variable alone at predicting CIN in patients with ACS that undergone percutaneous coronary intervention. The prediction was independent of baseline renal function and volume of contrast agent.
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Affiliation(s)
- Murat Ugur
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | | | - Ahmet Ekmekci
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Bozbay
- Department of Cardiology, Marmara University Hospital, Istanbul, Turkey
| | - Gurkan Karaca
- Clinic of Cardiology, Osmancik Government Hospital, Corum, Turkey
| | - Gokhan Cicek
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Bayram Koroglu
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Eyup Tusun
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Murat
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Burak Turan
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Uyarel
- Clinic of Cardiology, Bezmialem Vakif University Medical Hospital, Istanbul, Turkey
| | - Ahmet Lutfi Orhan
- Clinic of Cardiology, Medeniyet University Medical Hospital, Istanbul, Turkey
| | - Mehmet Eren
- Clinic of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
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Narula A, Mehran R, Weisz G, Dangas GD, Yu J, Genereux P, Nikolsky E, Brener SJ, Witzenbichler B, Guagliumi G, Clark AE, Fahy M, Xu K, Brodie BR, Stone GW. Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy. Eur Heart J 2014; 35:1533-40. [DOI: 10.1093/eurheartj/ehu063] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Elbey MA, Evliyaoglu O, Simsek Z, Oylumlu M, Akil MA, Aydın M, Bilik Z, Akyuz A, Inci U, Kayan F. Impact of insulin resistance on contrast induced nephropathy in patients undergoing percutaneous coronary intervention. Int J Diabetes Dev Ctries 2013. [DOI: 10.1007/s13410-013-0140-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Kim KH, Kim YS, Kuh SU, Park HS, Park JY, Chin DK, Kim KS, Cho YE. Time- and dose-dependent cytotoxicities of ioxitalamate and indigocarmine in human nucleus pulposus cells. Spine J 2013; 13:564-71. [PMID: 23406968 DOI: 10.1016/j.spinee.2013.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 10/11/2012] [Accepted: 01/13/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Ioxitalamate (Telebrix 300) is an ionic iodinated contrast medium commonly used for discography or percutaneous endoscopic lumbar discectomy (PELD), though it has side effects such as anaphylactic shock and renal toxicity. Indigocarmine is an organic compound dye with a distinctive blue color that is commonly used during PELD to stain the acidic, degenerated nucleus pulposus (NP). Although ioxitalamate and indigocarmine are widely used in spinal surgery, there have been no reports on their effects on NP cells. We studied the toxicities of both ioxitalamate and indigocarmine to NP cells. PURPOSE To determine the toxicities of both ioxitalamate and indigocarmine to NP cells in vitro. STUDY DESIGN In vitro, controlled study of the toxicities of both ioxitalamate and indigocarmine to human NP cells. METHODS Nucleus pulposus cells were obtained via discectomy from lumbar disc patients and isolated. Nucleus pulposus cells were cultured in three-dimensional (3D) alginate beads with 0.001, 0.1, 10, and 100 mg/mL ioxitalamate, 0.00001, 0.001, 0.1, and 10 mg/mL indigocarmine, or a mixture of both for 1, 2, or 3 days. The living cells were analyzed with trypan blue staining. Fluorescence Activated Cell Sorting analysis using Annexin V and propidium iodide and 3D alginate bead immunostaining was performed to identify live, apoptotic, and necrotic cells. RESULTS Ioxitalamate, indigocarmine, and their combination induced statistically significant NP cell injury that was both time- and dose dependent (p<.05). Also, at the same concentration, ioxitalamate was more cytotoxic than was indigocarmine or the combination (p<.05). All three treatments also showed dose-dependent cytotoxicity according to flow cytometry and immunostaining. CONCLUSIONS Ioxitalamate and indigocarmine are toxic to human NP cells in vitro in a time- and dose-dependent manner. We assume that ioxitalamate and indigocarmine may have similar effects in patients undergoing discography and PELD. Thus, we suggest that ioxitalamate and indigocarmine should be used carefully at low concentrations.
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Affiliation(s)
- Kyung-Hyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 712 Eonjuro, Gangnam-gu, Seoul 135-720, South Korea
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Tehrani S, Laing C, Yellon DM, Hausenloy DJ. Contrast-induced acute kidney injury following PCI. Eur J Clin Invest 2013; 43:483-90. [PMID: 23441924 DOI: 10.1111/eci.12061] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 02/03/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Coronary revascularization using percutaneous coronary intervention (PCI) is one of the major treatments for patients with stable coronary artery disease, with approximately 1.5 million patients undergoing PCI in the United States and Europe every year. An important neglected complication of PCI is contrast-induced acute kidney injury (CI-AKI). DESIGN In this article, we review the definition, pathogenesis and management of CI-AKI and highlight potential therapeutic options for preventing CI-AKI in post-PCI patients. RESULTS CI-AKI is an important but underdiagnosed complication of PCI that is associated with increased in-hospital morbidity and mortality. Patients with pre-existing renal impairment and diabetes are particularly susceptible to this complication post-PCI. Optimization of the patients' circulating volume remains the mainstay for preventing CI-AKI, although the best strategy for achieving this is still controversial. CONCLUSION Following PCI, CI-AKI is an overlooked complication which is associated with significant morbidity and mortality. In this article, we review the pathophysiology of CI-AKI in patients undergoing PCI and discuss the potential therapeutic options for preventing it.
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Affiliation(s)
- Shana Tehrani
- The Hatter Cardiovascular Institute, University College London, London, UK
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Aykan AÇ, Gül I, Gökdeniz T, Kalaycıoğlu E, Turan T, Boyacı F, Erkan H, Hatem E, Aykan DA, Celik S. Is coronary artery disease complexity valuable in the prediction of contrast induced nephropathy besides Mehran risk score, in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention? Heart Lung Circ 2013; 22:836-43. [PMID: 23628329 DOI: 10.1016/j.hlc.2013.03.085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 03/29/2013] [Accepted: 03/31/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The association of coronary artery disease complexity with contrast induced nephropathy (CIN) in patients with acute ST segment elevation myocardial infarction (STEMI) is inadequately evaluated and to our knowledge the association between SYNTAX score (SS) and Mehran score (MS) have not been studied. The aim of the present study is to clarify the incidence of CIN and to identify demographic, clinical and procedural variables associated with CIN in patients who underwent primary percutaneous coronary intervention (PPCI) due to acute STEMI, besides the association between MS and SS with CIN. METHODS We analysed the clinical data of 402 patients (309 male, 93 female, mean age 63.8 ± 12.65 year) with 179 (44.5%) anterior MI, 104 (25.9%) inferior MI, 119 (29.6%) inferior MI with right ventricular involvement who underwent PPCI. RESULTS We found that CIN was observed in 32.6% of patients. The SS (OR=1.037, %95CI=1.012-1.062, p=0.003), MS (OR=1.072, %95CI=1.025-1.121, p=0.003), HDL (OR=0.974, %95CI=0.949-0.999, p=0.044) were the independent predictors of CIN. The cut off value to show CIN for SS was 31.5 (sensitivity=79.4%, specificity=88.6%) and MS was 12.5 (sensitivity=73.3%, specificity=88.9%) in ROC curve analysis. CONCLUSION In conclusion, besides MS, SS may be a valuable marker to identify patients at high risk for CIN in patients undergoing primary percutaneous intervention.
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Affiliation(s)
- Ahmet Çağrı Aykan
- Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey.
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Kaya A, Kaya Y, Topçu S, Günaydin ZY, Kurt M, Tanboğa IH, Kalkan K, Aksakal E. Neutrophil-to-lymphocyte ratio predicts contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention. Angiology 2013; 65:51-6. [PMID: 23620308 DOI: 10.1177/0003319713484789] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated the relationship between baseline neutrophil-to-lymphocyte ratio (NLR) and contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI). Consecutive patients diagnosed with STEMI (n = 691) who underwent primary percutaneous coronary intervention (p-PCI) were included in the study. The CIN was defined as an increase in serum creatinine concentration ≥25% over baseline at 48 hours. Both NLR and C-reactive protein levels were significantly higher in the CIN group. There was a stronger correlation in patients with a known history of chronic kidney disease and in patients with a history of diabetes mellitus (DM). Advanced age, DM, low baseline glomerular filtration rate, reduced postprocedural ST resolution, high amount of contrast media, high NLR, and low left ventricular ejection fraction were independent predictors of CIN. The NLR may be used as a simple and reliable indicator of CIN in patients with STEMI who underwent p-PCI.
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Affiliation(s)
- Ahmet Kaya
- 1Department of Cardiology, Ordu University Medical School, Ordu, Turkey
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Neyra JA, Shah S, Mooney R, Jacobsen G, Yee J, Novak JE. Contrast-induced acute kidney injury following coronary angiography: a cohort study of hospitalized patients with or without chronic kidney disease. Nephrol Dial Transplant 2013; 28:1463-71. [PMID: 23585585 DOI: 10.1093/ndt/gft082] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Contrast-induced acute kidney injury (CIAKI) has been linked to unfavorable consequences. In routine clinical practice, small increases in serum creatinine (SCr) following coronary angiography tend to be underestimated, especially in patients without chronic kidney disease (CKD). METHODS We conducted a retrospective observational cohort study to analyze in-hospital and long-term outcomes of CIAKI following coronary angiography in patients with or without CKD (eGFR ≥ 60 mL/min/1.73 m(2)) from January 2008 through December 2009. CIAKI was defined as SCr either ≥ 25% or ≥ 0.5 mg/dL from baseline within 72 h after contrast exposure. Multivariable logistic regression for in-hospital mortality and Cox proportional hazards calculations for long-term mortality and requirement for dialysis were performed. RESULTS A total of 1160 patients were included in the study. CIAKI occurred in 19% of CKD patients and in 18% of non-CKD patients. In CKD and non-CKD patients, CIAKI was more frequent in patients requiring mechanical ventilation or inotropes or in those given furosemide, and it was associated with adverse in-hospital (prolonged hospitalization, acute dialysis and mortality) and long-term (increased creatinine, initiation of dialysis and mortality) outcomes. In multivariable analysis, CKD patients had greater in-hospital mortality if they developed CIAKI (adjusted OR 8, 95% CI 1.9-34.5, P = 0.005), and non-CKD patients had greater long-term mortality if they developed CIAKI (adjusted HR 2.2, 95% CI 1.2-4.1, P = 0.016). CONCLUSIONS CIAKI following coronary angiography was associated with adverse in-hospital and long-term outcomes in both CKD and non-CKD patients.
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Affiliation(s)
- Javier A Neyra
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Sinert R, Brandler E, Subramanian RA, Miller AC. Does the current definition of contrast-induced acute kidney injury reflect a true clinical entity? Acad Emerg Med 2012; 19:1261-7. [PMID: 23167857 DOI: 10.1111/acem.12011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 06/19/2012] [Accepted: 07/15/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Contrast-induced acute kidney injury (CI-AKI) is defined as either a 25% increase in or an absolute elevation in serum creatinine (SCr) of 0.5 mg/dL, 48 to 72 hours after parenteral contrast exposure. The objective of this study was to compare the incidence and complications of AKI between patients exposed and those unexposed to intravenous (IV) contrast. METHODS This was a retrospective cohort study using the electronic medical record of adult patients (>18 years) with and without contrast-enhanced abdominal or chest computed tomography (CT) between May 2008 and April 2009. Inclusion criteria were emergency department (ED) patients with normal renal function who received either a contrast-enhanced abdominal or a contrast-enhanced chest CT, compared to those unexposed to IV contrast, with a repeat SCr within 48 to 72 hours. Exclusion criteria were contrast exposure within 7 days before the index visit. CI-AKI in the contrast-exposed group and AKI in the contrast-unexposed group were defined by the same changes in SCr 48 to 72 hours after contrast or ED admission. Data were described by proportions or medians with 95% confidence intervals (CIs) or interquartile ranges (IQR; 25% to 75%). Group comparisons were by Mann-Whitney U or Fisher's exact test (α = 0.05, two tails). RESULTS The contrast-exposed (n = 773) and contrast-unexposed (n = 2,956) patients were evenly matched for initial demographic, renal, and metabolic parameters. The incidence of CI-AKI/AKI was significantly higher for the patients unexposed versus exposed to contrast (8.96% vs. 5.69%, p = 0.003). There was no significant difference in mortality rates between contrast-exposed and unexposed patients (9.09% vs. 6.79%, p = 0.533). CONCLUSIONS The definition of CI-AKI for ED patients with normal renal function may not represent a true clinical entity and the definition warrants revision.
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Affiliation(s)
- Richard Sinert
- The Department of Emergency Medicine; SUNY-Downstate Medical Center; Brooklyn NY
| | - Ethan Brandler
- The Department of Emergency Medicine; SUNY-Downstate Medical Center; Brooklyn NY
| | | | - Andrew C. Miller
- The Critical Care Medicine Department; National Institutes of Health Clinical Center; Bethesda MD
- The Department of Medicine; Division of Pulmonary, Allergy and Critical Care Medicine; University of Pittsburgh; Pittsburgh PA
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Wi J, Ko YG, Shin DH, Kim JS, Kim BK, Choi D, Ha JW, Hong MK, Jang Y. Prediction of Contrast-Induced Nephropathy With Persistent Renal Dysfunction and Adverse Long-term Outcomes in Patients With Acute Myocardial Infarction Using the Mehran Risk Score. Clin Cardiol 2012; 36:46-53. [PMID: 23027701 DOI: 10.1002/clc.22060] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 08/31/2012] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) has been generally considered to be transient and associated with unfavorable clinical outcomes. HYPOTHESIS The aim of this study was to investigate whether Mehran risk score could predict CIN with persistent renal dysfunction and long-term clinical outcomes in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). METHODS We analyzed the clinical data of 1041 AMI patients. The primary end point was defined as major adverse cardiovascular and cerebrovascular event (MACCE) including death, reinfarction, target vessel revascularization, heart failure requiring hospital admission, and stroke. Patients were categorized into 4 groups according to risk scores: low (≤ 5, n = 596), moderate (6-10, n = 265), high (11-15, n = 111), and very high (≥16, n = 69). RESULTS Among the 148 patients (14.2%) who developed CIN, persistent renal dysfunction was observed in 68 patients. Presence in high- or very high-risk groups was the most important independent risk factor of CIN with persistent renal dysfunction (odds ratio: 3.35, 95 confidence interval [CI]: 1.89-5.92, P < 0.001). Furthermore, patients in higher-risk groups experienced significantly more MACCE and mortality 2 years after PCI. Using multivariate analysis, significant increase in the hazard ratio (HR) for MACCE was noted in moderate- (HR: 1.40, 95% CI: 0.97-2.03, P = 0.075), high- (HR 1.96, 95% CI: 1.22-3.15, P = 0.006), and very high-risk (HR 2.40, 95% CI: 1.36-4.21, p = 0.002) groups, compared with the low-risk group. The very high-risk group had approximately 6-fold increase in mortality over the low-risk group (HR: 6.22, 95% CI: 2.77-13.95, P < 0.001). CONCLUSIONS Mehran risk score predicted CIN with persistent renal dysfunction and long-term clinical outcomes in patients with AMI.
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Affiliation(s)
- Jin Wi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
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Droppa M, Desch S, Blase P, Eitel I, Fuernau G, Schuler G, Adams V, Thiele H. Impact of N-acetylcysteine on contrast-induced nephropathy defined by cystatin C in patients with ST-elevation myocardial infarction undergoing primary angioplasty. Clin Res Cardiol 2011; 100:1037-43. [PMID: 21710343 DOI: 10.1007/s00392-011-0338-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 06/20/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this study was to assess the effects of N-acetylcysteine (N-ACC) on contrast-induced nephropathy (CIN) defined by Cystatin C (Cys-C) serum levels and to evaluate the influence of Cys-C on clinical outcome in patients with ST-elevation myocardial infarction (STEMI). METHODS In total, 251 patients with STEMI undergoing primary percutaneous coronary intervention (PCI) were randomized to either high-dose N-ACC (2 × 1200 mg/d for 48 h) with optimal hydration or placebo plus optimal hydration. Serum Cys-C was measured at baseline, immediately, 24, 48 and 72 h after PCI. CIN was defined as an increase in serum Cys-C levels of 25% or more from baseline within 72 h after PCI. Major adverse cardiac events (MACE)--defined as death, recurrent infarction and congestive heart failure--within 6 months were recorded. RESULTS Baseline Cys-C was 1294 ± 611 and 1352 ± 811 ng/mL (p = 0.54) for the N-ACC and placebo group, respectively. There was a steady increase in Cys-C in both groups within the first 72 h after randomization. CIN occurred in 74.6 and in 70.4% of patients in the N-ACC and placebo group, respectively (p = 0.46). The magnitude of increase in the serum concentration of Cys-C was an independent predictor for MACE after 6 months of follow-up. CONCLUSIONS High-dose N-ACC does not provide additional benefit over placebo with respect to Cys-C defined CIN in STEMI patients undergoing primary PCI. The magnitude of increase in Cys-C serum levels in the early course after STEMI is a predictor of medium-term MACE.
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Affiliation(s)
- Michal Droppa
- Department of Internal Medicine/Cardiology, University of Leipzig, Heart Center, Leipzig, Germany
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Serafin Z, Karolkiewicz M, Gruszka M, Stróżecki P, Lasek W, Odrowąż-Sypniewska G, Manitius J, Beuth W. High incidence of nephropathy in neurosurgical patients after intra-arterial administration of low-osmolar and iso-osmolar contrast media. Acta Radiol 2011; 52:422-9. [PMID: 21498279 DOI: 10.1258/ar.2011.100501] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Percutaneous endovascular examinations and interventions require significant amounts of iodinated contrast media (CM) and have been reported to be complicated by an increased incidence of post-contrast nephropathy. PURPOSE To evaluate renal function, the incidence of post-contrast nephropathy, and risk factors after interventional procedures in neurosurgical patients after intra-arterial administration of a low-osmolar contrast medium (LOCM) versus an iso-osmolar contrast medium (IOCM). MATERIAL AND METHODS This single-center, prospective, randomized, double-blinded study included 92 patients in its final analysis (mean age 49.6 ± 12.6 years, 29.3% men, mean eGFR 97.8 ± 26.3 mL/min/1.73 m(2)). LOCM was used in 48 patients (52.2%) and IOCM in 44 patients (47.8%). The patients were given an average of 151.2 ± 52.1 mL of contrast medium intra-arterially. Serum creatinine (SCr), urinary N-acetyl-β-glucosaminidase (NAG) excretion, and creatinine clearance (CCr) were measured at baseline, and on days 1 and 3 after the procedure. RESULTS Baseline risk factors, renal functional parameters, and average CM doses were not statistically different between the two groups. SCr, NAG, and CCr values did not differ significantly between the LOCM and IOCM groups on days 1 and 3 after CM administration. Nephropathy developed in 21 cases (22.8%): 13 (27.1%) after LOCM use and 8 (18.2%) after IOCM; (P = NS). The only significant risk factors of CIN were the diabetes (P = 0.0466) and atherosclerosis (P = 0.0498). CONCLUSION We found a high incidence of nephropathy in neurosurgical patients after intra-arterial CM administration. The renal function values and incidence of nephropathy following LOCM administration were not statistically different from those following IOCM administration.
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Affiliation(s)
| | | | | | - Paweł Stróżecki
- Department of Nephrology, Hypertension and Internal Diseases
| | | | | | - Jacek Manitius
- Department of Nephrology, Hypertension and Internal Diseases
| | - Wojciech Beuth
- Department of Neurosurgery and Neurotraumatology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
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Wang Y, Fu X, Wang X, Jia X, Gu X, Zhang J, Su J, Hao G, Jiang Y, Fan W, Wu W, Li S. Protective Effects of Anisodamine on Renal Function in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. TOHOKU J EXP MED 2011; 224:91-7. [DOI: 10.1620/tjem.224.91] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yanbo Wang
- Department of Cardiology, the Second Hospital of Hebei Medical University
| | - Xianghua Fu
- Department of Cardiology, the Second Hospital of Hebei Medical University
| | - Xuechao Wang
- Department of Cardiology, the Second Hospital of Hebei Medical University
| | - Xinwei Jia
- Department of Cardiology, the Second Hospital of Hebei Medical University
| | - Xinshun Gu
- Department of Cardiology, the Second Hospital of Hebei Medical University
| | - Jing Zhang
- Department of Cardiology, the Second Hospital of Hebei Medical University
| | - Jianling Su
- Department of Cardiology, the Second Hospital of Hebei Medical University
| | - Guozhen Hao
- Department of Cardiology, the Second Hospital of Hebei Medical University
| | - Yunfa Jiang
- Department of Cardiology, the Second Hospital of Hebei Medical University
| | - Weize Fan
- Department of Cardiology, the Second Hospital of Hebei Medical University
| | - Weili Wu
- Department of Cardiology, the Second Hospital of Hebei Medical University
| | - Shiqiang Li
- Department of Cardiology, the Second Hospital of Hebei Medical University
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Ma G, Yu D, Cai Z, Ni C, Xu R, Lan B, Chen P, Zhu Z. Contrast-induced nephropathy in postmenopausal women undergoing percutaneous coronary intervention for acute myocardial infarction. TOHOKU J EXP MED 2010; 221:211-9. [PMID: 20551600 DOI: 10.1620/tjem.221.211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Contrast-induced nephropathy (CIN) is a complex syndrome of acute kidney injury induced by exposure to intravascular contrast media. CIN occurs frequently in patients undergoing urgent percutaneous coronary intervention (PCI) and is associated with poor outcomes, making it a major challenge faced by interventional cardiologists. It has been suggested that female sex is a risk factor for development of CIN following PCI. However, no data exist in the literature concerning the risks of postmenopausal women with acute myocardial infarction (AMI) developing CIN after undergoing urgent PCI. To explore the incidence, risk factors and in-hospital outcomes of CIN in this special population, we analyzed 69 postmenopausal women with AMI treated with urgent PCI. CIN was defined as a relative increase of >25% or an absolute increase of >or=0.5 mg/dL in serum creatinine concentration from the baseline value 72 h after exposure to contrast medium. We found 1) the incidence of CIN was 37.68%; 2) patients with CIN had worse in-hospital outcomes, including longer hospital stay and more in-hospital adverse events; and 3) in multivariate logistic analysis, independent risk factors for CIN included a longer menopausal duration and the implantation of an intra-aortic balloon pump (an indirect indicator of hemodynamic instability). These results indicate that CIN is a frequent complication associated with worse in-hospital outcomes in postmenopausal women with AMI who are undergoing urgent PCI, particularly those with longer menopausal duration and hemodynamic instability. It is therefore necessary to pay more attention to preventive strategies for renal protection in this special population.
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Affiliation(s)
- Guizhou Ma
- Department of Cardiology, Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong Province, PR China
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Loh Y, McArthur DL, Vespa P, Shi ZS, Liebeskind DS, Jahan R, Gonzalez NR, Starkman S, Saver JL, Tateshima S, Duckwiler GR, Viñuela F. The risk of acute radiocontrast-mediated kidney injury following endovascular therapy for acute ischemic stroke is low. AJNR Am J Neuroradiol 2010; 31:1584-7. [PMID: 20522566 DOI: 10.3174/ajnr.a2136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular therapy is an alternative for the treatment of AIS resulting from large intracranial arterial occlusions that depends on the use of iodinated RCM. The risk of RCM-mediated AKI following endovascular therapy for AIS may be different from that following coronary interventions because patients may not have identical risk factors. MATERIALS AND METHODS All consecutive patients with large-vessel AIS undergoing endovascular therapy were prospectively recorded. We recorded the baseline kidney function, and RCM-AKI was assessed according to the AKIN criteria at 48 hours after RCM administration. We compared the rate of RCM-AKI 48 hours after the procedure and sought to determine whether any preexisting factors increased the risk of RCM-AKI. RESULTS We identified 99 patients meeting inclusion criteria. The average volume of contrast was 189 ± 71 mL, and the average creatinine change was -4.6% at 48 hours postangiography. There were 3 patients with RCM-AKI. Although all 3 patients died as a result of their strokes, return to baseline creatinine levels occurred before death. There was a trend toward higher rates of premorbid diabetes mellitus, chronic renal insufficiency, preadmission statin and NSAID use, and a higher serum creatinine level on admission for the RCM-AKI group. The volume of procedural contrast was similar between groups (those with and those without RCM-AKI) (P = .5). CONCLUSIONS In this small study, the rate of RCM-AKI following endovascular intervention for AIS was very low. A much larger study is required to determine its true incidence.
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Affiliation(s)
- Y Loh
- Division of Neurosurgery, David Geffen School of Medicine at the University of California at Los Angeles, CA, USA.
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