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Sakellariou XM, Katsouras CS, Papafaklis MI, Floros C, Michalis LK, Karmpaliotis D. Absolute zero-contrast percutaneous coronary interventions: An intravascular ultrasound-guided case series and literature review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 62:95-104. [PMID: 38135569 DOI: 10.1016/j.carrev.2023.12.008] [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] [Received: 11/07/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Contrast media (CM)-associated adverse effects including mainly acute kidney injury and hypersensitivity reactions still remain a significant treatment burden to vulnerable patients requiring percutaneous coronary intervention (PCI). The complete omission of CM administration accompanied by intravascular ultrasound (IVUS) guidance may offer an appropriate revascularization treatment. METHODS We hereby present a case series of four patients with challenging coronary lesions and relative/absolute contraindications to CM use [(hypersensitivity reaction owning to CM, history of contrast-induced acute kidney injury, solitary kidney, or advanced chronic kidney disease (CKD)] who underwent absolute zero-contrast IVUS-guided PCI following a predetermined protocol. RESULTS The initial diagnostic angiography was reviewed for landmark identification, and multiple guidewires created a metallic road map providing additional landmarks and protected side branches. IVUS imaging was performed to determine lesion length, reference segments and landing zones, assess stent expansion/apposition and identify major complications. All procedures were successfully completed without any CM administration, renal function deterioration, pericardial effusion, or stent edge dissection. CONCLUSIONS We demonstrated the feasibility of absolute zero-contrast IVUS-guided PCI in patients with complex coronary lesions susceptible to CM-associated adverse effects. Since the safety of this strategy is well-documented in patients with CKD and challenging lesions morphology even in acute settings, evidence-based validation of this approach is capable of changing the otherwise conservative treatment of vulnerable patients where even minimum doses of CM may have detrimental effects. SUMMARY FOR THE ANNOTATED TABLE OF CONTENTS Patients with vulnerable renal function as well as former hypersensitivity reaction to contrast media encounter a significant treatment burden regarding coronary artery disease. Zero-contrast IVUS-guided strategy based on a predetermined protocol provides a feasible alternative approach in patients susceptible to contrast media-associated adverse effects even in the presence of complex coronary lesions.
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Affiliation(s)
| | - Christos S Katsouras
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece
| | | | - Christos Floros
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece
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Fong KY, Low CHX, Chan YH, Ho KW, Keh YS, Chin CT, Chin CY, Fam JM, Wong N, Idu M, Wong ASL, Lim ST, Koh TH, Tan JWC, Yeo KK, Yap J. Role of Invasive Strategy for Non-ST-Elevation Myocardial Infarction in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 205:369-378. [PMID: 37639763 DOI: 10.1016/j.amjcard.2023.07.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
Patients with chronic kidney disease (CKD) have traditionally been excluded from randomized trials. We aimed to compare percutaneous coronary intervention versus conservative management, and early intervention (EI; within 24 hours of admission) versus delayed intervention (DI; after 24 to 72 hours of admission) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and concomitant CKD. An electronic literature search was performed to search for studies comparing invasive management to conservative management or EI versus DI in patients with NSTEMI with CKD. The primary outcome was all-cause mortality; secondary outcomes were acute kidney injury (AKI) or dialysis, major bleeding, and recurrent MI. Hazard ratios (HRs) for the primary outcome and odds ratios for secondary outcomes were pooled in random-effects meta-analyses. Eleven studies (140,544 patients) were analyzed. Invasive management was associated with lower mortality than conservative management (HR 0.62, 95% confidence interval 0.57 to 0.67, p <0.001, I2 = 47%), with consistent benefit across all CKD stages, except CKD 5. There was no significant mortality difference between EI and DI, but subgroup analyses showed significant benefit for EI in stage 1 to 2 CKD (HR 0.75, 95% confidence interval 0.58 to 0.97, p = 0.03, I2 = 0%), with no significant difference in stage 3 and 4 to 5 CKD. Invasive strategy was associated with higher odds of AKI or dialysis and major bleeding, but lower odds of recurrent MI compared with conservative management. In conclusion, in patients with NSTEMI and CKD, an invasive strategy is associated with significant mortality benefit over conservative management in most patients with CKD, but at the expense of higher risk of AKI and bleeding. EI appears to benefit those with early stages of CKD. Trial Registration: PROSPERO CRD42023405491.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chloe Hui Xuan Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kay Woon Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Yann Shan Keh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Chee Tang Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Chee Yang Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Jiang Ming Fam
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Ningyan Wong
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Muhammad Idu
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Aaron Sung Lung Wong
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Soo Teik Lim
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Tian Hai Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Jack Wei Chieh Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore.
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Nandhakumar V, Pakshirajan B, Chopra A, Anandan H, Janakiraman E, Uthayakumaran K, Kalidoss L, Victor SM, Ajit MS. Safety and feasibility of intravascular ultrasound guided zero-contrast percutaneous coronary intervention-A prospective study. Int J Cardiol 2022; 353:22-28. [PMID: 35065155 DOI: 10.1016/j.ijcard.2022.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/02/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are published reports of safety and feasibility of percutaneous coronary intervention (PCI) without contrast, using intravascular ultrasound (IVUS) and coronary physiology guidance in chronic kidney disease population. We prospectively evaluated the safety and feasibility of zero-contrast PCI technique. METHODS In this prospective study, we hypothesized that PCI is feasible without contrast, using IVUS guidance alone without mandatory coronary physiology to rule out slow-flow or no-flow at the end of PCI in a population at risk of contrast-induced acute kidney injury (CI-AKI). In this study, we included 31 vessels in 27 patients at risk of CI-AKI and assessed the primary outcome of technical success at the end of PCI. Major adverse cardio-cerebro vascular events (MACCE) and percent change in estimated glomerular filtration rate(eGFR) one month after PCI were the secondary outcomes of the study. RESULTS The primary outcome was met in 87.1%(n = 27) of the procedures. Technical failure was seen in 12.9%(n = 4) of the procedures. None of the patients developed MACCE at one-month follow-up. The median percent change in eGFR at one-month follow-up was -8.19%(-24.40%, +0.92%). There was no newer initiation of renal replacement therapy at one-month follow-up. CONCLUSIONS Zero-contrast PCI is safe and feasible in selective coronary anatomies with IVUS guidance. Coronary physiology is not mandatory to rule out slow-flow or no-flow at the end of procedure. Contrast may be needed to tide over the crisis during the possible complications, namely slow-flow, geographical miss and intraprocedural thrombus.
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Affiliation(s)
- Vasu Nandhakumar
- Institute of Cardio-vascular Diseases, The Madras Medical Mission Hospital, Chennai, Tamilnadu, India.
| | - Balaji Pakshirajan
- Institute of Cardio-vascular Diseases, The Madras Medical Mission Hospital, Chennai, Tamilnadu, India
| | - Aashish Chopra
- Institute of Cardio-vascular Diseases, The Madras Medical Mission Hospital, Chennai, Tamilnadu, India
| | - Harini Anandan
- Institute of Cardio-vascular Diseases, The Madras Medical Mission Hospital, Chennai, Tamilnadu, India
| | - Ezhilan Janakiraman
- Institute of Cardio-vascular Diseases, The Madras Medical Mission Hospital, Chennai, Tamilnadu, India
| | | | - Latchumanadhas Kalidoss
- Institute of Cardio-vascular Diseases, The Madras Medical Mission Hospital, Chennai, Tamilnadu, India
| | - Suma M Victor
- Institute of Cardio-vascular Diseases, The Madras Medical Mission Hospital, Chennai, Tamilnadu, India
| | - Mullasari S Ajit
- Institute of Cardio-vascular Diseases, The Madras Medical Mission Hospital, Chennai, Tamilnadu, India
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Nie Z, Liu Y, Wang C, Sun G, Chen G, Lu Z. Safe Limits of Contrast Media for Contrast-Induced Nephropathy: A Multicenter Prospective Cohort Study. Front Med (Lausanne) 2021; 8:701062. [PMID: 34490295 PMCID: PMC8417794 DOI: 10.3389/fmed.2021.701062] [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: 04/29/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The safe level of contrast media volume (CV) is an important modifiable risk factor for contrast-induced nephropathy (CIN). The safe limit of CV remains unclear and is limited to single-center studies. Our objective was to determine the association between the ratio of contrast volume-to-glomerular filtration (CV/GFR) and CIN in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). Methods: We assessed the association between CV/GFR and the risk of CIN in 4,254 patients undergoing CAG or PCI from the year 2013 to 2016 and enrolled in the REICIN (REduction of rIsk for Contrast-Induced Nephropathy), a prospective, multicenter, observational cohort study. CV/GFR was calculated at the five primary GFR equation. Results: Sixty-nine (1.7%) patients with a median contrast volume-to-chronic kidney disease epidemiology collaboration (CV/CKD-EPI) ratio of 2.16 (1.30-3.93) have suffered from CIN. The CV/CKD-EPI demonstrated the best performance of model fit, discrimination (area under curve = 0.736), calibration, reclassification, and equation conciseness (1 variable). The CV/CKD-EPI ≥1.78 was the statistical significance associated with CIN [adjusted odds ratio, 4.64 (2.84-7.56); p < 0.001]. Furthermore, similar results were found in the subgroup analyses. Conclusions: The CV/CKD-EPI showed the best performance in patients undergoing CAG or PCI. CV/CKD-EPI ≥1.78 could be a more reliable and convenient predictor of CIN. Intraprocedural preventive measures should include a priori calculation of CV/GFR to limit contrast volume.
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Affiliation(s)
- Zhiqiang Nie
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Epidemiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chao Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoli Sun
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guo Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kelemen JA, Kaserer A, Jensen KO, Stein P, Seifert B, Simmen HP, Spahn DR, Pape HC, Neuhaus V. Prevalence and outcome of contrast-induced nephropathy in major trauma patients. Eur J Trauma Emerg Surg 2020; 48:907-913. [PMID: 32948886 PMCID: PMC7500990 DOI: 10.1007/s00068-020-01496-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
Background Contrast-induced nephropathy (CIN) has been well investigated in patients undergoing coronary angiography, but not in trauma patients. The main aim of this study was to determine the prevalence and to investigate independent risk factors for the development of CIN. Methods Between 2008 and 2014, all pre-hospital intubated major trauma patients with documented serum creatinine levels (SCr) undergoing a contrast-enhanced whole-body CT at admission were retrospectively analyzed. CIN was defined as a relative increase in SCr > 25% over the baseline value or an absolute SCr increase of > 44 µmol/l within 72 h. Univariate and multivariable regression analyses were performed to identify significant risk factors. A p value of < 0.01 was considered statistically significant and a p value of 0.01–0.049 suggested evidence. Results Of 284 analyzed patients, 41 (14%) met the criteria for CIN. There is suggestive evidence that age and lactate level influenced the development of CIN. Six patients (15%) had hemodialysis in the CIN-group and eight (3.3%) in the group without CIN. Complication and mortality rate was higher in patients with CIN (71% vs. 56% and 32% vs. 23%, respectively). CIN was not an independent risk factor for complications or mortality while controlling for age, gender, injury severity score, and lactate level. The length of stay was not affected by CIN. Conclusion CIN occurs frequently in trauma patients, but is not an independent risk factor for complications or mortality. Therefore, contrast enhanced whole-body CT can safely be performed in trauma patients.
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Affiliation(s)
- Julian Alexander Kelemen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Kai Oliver Jensen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Philipp Stein
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Institute of Anesthesiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8400 Winterthur, Switzerland
| | - Burkhardt Seifert
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Hans-Peter Simmen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Hans-Christoph Pape
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Valentin Neuhaus
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
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Nakahashi T, Tada H, Sakata K, Yakuta Y, Yoshida T, Tanaka Y, Nomura A, Terai H, Horita Y, Ikeda M, Namura M, Takamura M, Kawashiri MA. Impact of concomitant peripheral artery disease on contrast-induced acute kidney injury and mortality in patients with acute coronary syndrome after percutaneous coronary intervention. Heart Vessels 2020; 35:1360-1367. [PMID: 32342211 DOI: 10.1007/s00380-020-01614-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/17/2020] [Indexed: 11/28/2022]
Abstract
Subclinical peripheral artery disease (PAD) might be associated with pathophysiology of contrast-induced acute kidney injury (CI-AKI). We hypothesized that concomitant PAD in patients with the acute coronary syndrome (ACS) would represent a high-risk subgroup with a greater incidence of CI-AKI, both of which lead to higher mortality after percutaneous coronary intervention (PCI). Six hundred and seventy-five consecutive patients with ACS who underwent PCI and examination of ankle-brachial index (ABI) were analyzed retrospectively. The presence of PAD was defined as an ABI < 0.9. We investigated whether (1) PAD was an independent predictor of CI-AKI (≥ 0.3 mg/dL or ≥ 50% relative increase in serum creatinine within 48 h after PCI) and (2) PAD and CI-AKI were independently associated with long-term mortality. Of the 675 patients with ACS, 114 (17%) exhibited PAD. The incidence of CI-AKI was significantly higher in PAD patients, compared with the remaining patients (12% vs. 4%, p < 0.001). Multivariate logistic regression analysis revealed that the presence of PAD was an independent predictor for the development of CI-AKI [odds ratio 2.50, 95% confidence interval (CI) 1.07-5.73, p < 0.05]. During the median 4-year follow-up, there were 65 incidents of all-cause death. In the multivariate Cox proportional hazard regression analysis, the presence of PAD [hazard ratio (HR) 2.08, 95% CI 1.17-3.65, p < 0.05] and CI-AKI (HR 2.23, 95% CI 1.08-4.26, p < 0.05) were associated with an increased risk of all-cause mortality. Assessment of ABI provides useful information for predicting CI-AKI and long-term mortality in patients with ACS after PCI.
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Affiliation(s)
- Takuya Nakahashi
- Department of Cardiology, Takaoka City Hospital, 4-1, Takara-machi, Takaoka, Toyama, 933-8550, Japan.
| | - Hayato Tada
- Department of Cardiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenji Sakata
- Department of Cardiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Yohei Yakuta
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan
| | - Taiji Yoshida
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan
| | - Yoshihiro Tanaka
- Department of Cardiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Akihiro Nomura
- Department of Cardiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Hidenobu Terai
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan
| | - Yuki Horita
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan
| | - Masatoshi Ikeda
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan
| | - Masanobu Namura
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan
| | - Masayuki Takamura
- Department of Cardiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
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Use of Contrast Medium Volume to Guide Prophylactic Hydration to Prevent Acute Kidney Injury After Contrast Administration: A Meta-Analysis. AJR Am J Roentgenol 2020; 215:15-24. [PMID: 32348183 DOI: 10.2214/ajr.19.22325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE. The purpose of this study was to determine whether contrast medium volume and method of administration and baseline estimated glomerular filtration rate influence the efficacy of prophylactic hydration for prevention of acute kidney injury after contrast administration. MATERIALS AND METHODS. An online search of PubMed conducted on August 25, 2017, produced a total of 697 studies. After the reports were reviewed, nine were included in this study. The extracted data on all patients in these studies were separated into a group that received prophylactic hydration and a group that did not. The following three parameters were used for subgroup analysis: contrast medium volume, contrast administration method, and baseline estimated glomerular filtration rate. The t test was performed, and study-level odds ratios with 95% CIs and p values were calculated. Tests of heterogeneity were conducted. RESULTS. When the volume of contrast agent administered exceeded 100 mL, hydration was beneficial in the prevention of contrast-induced acute kidney injury (odds ratio, 0.546). If the volume was less than 100 mL, hydration had no efficacy in preventing contrast-induced acute kidney injury (odds ratio, 0.917). Administration route and baseline estimated glomerular filtration rate exerted no effect on the efficacy of prophylactic hydration. CONCLUSION. For patients who receive less than 100 mL of contrast medium, the prevalent practice for contrast-enhanced CT studies, prophylactic hydration may not be necessary, regardless of the estimated glomerular filtration rate or route of contrast administration. For patients undergoing procedures requiring administration of large volumes of contrast medium, however, hydration is recommended to prevent contrast-induced acute kidney injury.
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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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Gurm HS, Mavromatis K, Bertolet B, Kereiakes DJ, Amin AP, Shah AP, Hanzel GS, Rao S, Thomas JL, Kumar G. Minimizing radiographic contrast administration during coronary angiography using a novel contrast reduction system: A multicenter observational study of the DyeVert™ plus contrast reduction system. Catheter Cardiovasc Interv 2018; 93:1228-1235. [PMID: 30393942 DOI: 10.1002/ccd.27935] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/30/2018] [Accepted: 09/23/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate contrast media (CM) volume (CMV) saved using the DyeVert™ Plus Contrast Reduction System (DyeVert Plus System, Osprey Medical) in patients undergoing diagnostic coronary angiogram (CAG) and/or percutaneous coronary interventional (PCI) procedures performed with manual injections. BACKGROUND Current guidelines advocate for monitoring and minimization of the total volume of CM in chronic kidney disease (CKD) patients undergoing invasive cardiac procedures. The DyeVert Plus System is an FDA cleared device designed to reduce CMV delivered during angiography and permit real-time CMV monitoring. METHODS We performed a multicenter, single-arm, observational study. Eligible subjects were ≥ 18 years old with baseline estimated glomerular filtration rate (eGFR) 20-60 mL/min/1.73 m2 . The primary endpoint was % CMV saved over the total procedure. A secondary objective was to evaluate adverse events (AEs) related to DyeVert Plus System or to CM use. RESULTS A total of 114 subjects were enrolled at eight centers. Mean age was 72 ± 9 years, 72% were male, and mean body mass index was 29 ± 5. Baseline eGFR was 43 ± 11 mL/min/1.73 m2 . CAG-only was performed in 65% of cases. One hundred and five subjects were evaluable for the primary endpoint. Mean CMV attempted was 112 ± 85 mL (range 22-681) and mean CMV delivered was 67 ± 51 mL (range 12-403), resulting in an overall CMV savings of 40.1 ± 8.8% (95% CI 38.4, 41.8; P < 0.0001) per procedure. Image quality was maintained in all but one case where the system was turned off for one injection. No DyeVert Plus System-related AEs were reported. Acute kidney injury (AKI; defined as serum creatinine rise of >0.3 mg/dL from baseline) was reported in 11 cases with seven occurring in subjects with baseline eGFR < 30 and three AKI events were attributed to CM. AKI rates increased as CMV/eGFR ratios increased. CONCLUSIONS These data suggest DyeVert Plus System use in CKD patients undergoing CAG and/or PCI results in clinically meaningful CMV savings while maintaining image quality.
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Affiliation(s)
- Hitinder S Gurm
- Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kreton Mavromatis
- Department of Medicine, Cardiology Division, Atlanta VA Medical Center, Emory University School of Medicine, Decatur, Georgia
| | - Barry Bertolet
- Cardiology Associates Research, LLC, North Mississippi Medical Center, Tupelo, Mississippi
| | - Dean J Kereiakes
- Christ Hospital, Heart and Vascular Center, Lindner Research Center, Cincinnati, Ohio
| | - Amit P Amin
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Atman P Shah
- Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - George S Hanzel
- Department of Medicine, Division of Cardiology, William Beaumont Hospital, Heart and Vascular, Royal Oak, Michigan
| | | | - Joseph L Thomas
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, California
| | - Gautam Kumar
- Department of Medicine, Cardiology Division, Atlanta VA Medical Center, Emory University School of Medicine, Decatur, Georgia
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10
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Jia KQ, Blais D, Porter K, Boudoulas KD, Lilly S. The effect of establishing pre-angiography thresholds on contrast utilization. J Interv Cardiol 2017; 31:430-435. [PMID: 29266400 DOI: 10.1111/joic.12482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/22/2017] [Accepted: 11/28/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Contrast induced nephropathy is linked to contrast utilization and strategies for minimizing renal injury are incorporated into many laboratories that perform coronary angiography. Contrast limits have been described, below which there is minimal incremental increase in the risk of renal injury. Whether a priori acknowledgement of these limits as part of a contrast "Time-Out" reduces contrast utilization has not been established. In this study, we investigate the effect of verbalizing pre-angiography and ½ time contrast thresholds on contrast utilization and associated clinical outcomes. METHODS We retrospectively reviewed 5265 cases of coronary angiography (984 with contrast thresholds defined pre-procedure compared to 4281 without pre-defined contrast thresholds). There were two primary endpoints: (1) proportion of procedures that utilized an amount of contrast ≤ threshold, and (2) median difference between amount of contrast utilized and the contrast threshold. Secondary outcomes incorporated indices of renal function, and included changes in serum creatinine levels, eGFR, and CKD stage. RESULTS Compared to pre-"Time-Out" group, the post-"Time-Out" group had a higher proportion of procedures with contrast ≤ stated contrast threshold (88% vs 84%, P < 0.002), and a lower amount of total contrast volume (88 mL [IQR 60-136] versus 78 mL [IQR 53-119]). The post-"Time-Out" group also had a lower incidence of any increase in post-procedure serum creatinine (45% vs 36%; P = 0.04), and a larger median decrease of pre- to post-procedure eGFR (P = 0.04). CONCLUSION Acknowledgement of contrast threshold as part of a contrast "Time-Out" is associated with reduced overall contrast utilization, and likely minimizes risks of contrast-induced nephropathy.
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Affiliation(s)
- Kelly Q Jia
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Danielle Blais
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kyle Porter
- Department of Biostatistics, The Ohio State University, Columbus, Ohio
| | - Konstantinos D Boudoulas
- Department of Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Scott Lilly
- Department of Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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11
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Zhao JB, Liu Y, Wu DX, Chen JY, Duan CY, Chen SQ, Tan N. Contrast Volume to Cystatin C-Based Glomerular Filtration Ratio Predicts the Risk of Contrast-Induced Nephropathy After Cardiac Catheterization. Angiology 2016; 68:207-215. [PMID: 27166381 DOI: 10.1177/0003319716648027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Cystatin C is considered to be a better alternative to creatinine for estimating glomerular filtration rate (GFR). The aim of this study was to investigate whether a contrast volume to estimated GFR based on cystatin C (V/eGFRcys) is a better predictor of contrast-induced nephropathy (CIN). We enrolled 1195 consecutive patients undergoing elective cardiac catheterization. Receiver–operating characteristic (ROC) curves were used to identify the optimal cutoff value of V/eGFRcys for detecting CIN. Multivariate regression models were used to evaluate whether V/eGFRcys is an independent risk factor for CIN. A total of 19 (1.6%) patients developed CIN. There was a significant association between a higher V/eGFRcys ratio and CIN risk ( P = .008). A ROC curve analysis indicated that a V/eGFRcys ratio of 2.29 was a fair discriminator for CIN. After adjusting for other known CIN risk factors, V/eGFRcys ratios >2.29 remained significantly associated with CIN (odds ratio = 2.93, 95% confidence interval: 1.02-8.44, P = .047). In conclusion, a V/eGFRcys >2.29 was a significant and independent predictor of CIN after cardiac catheterization.
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Affiliation(s)
- Jian-bin Zhao
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Deng-xuan Wu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ji-yan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chong-yang Duan
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Shi-qun Chen
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Xu J, Zhang M, Ni Y, Shi J, Gao R, Wang F, Dong Z, Zhu L, Liu Y, Xu H. Impact of low hemoglobin on the development of contrast-induced nephropathy: A retrospective cohort study. Exp Ther Med 2016; 12:603-610. [PMID: 27446250 PMCID: PMC4950745 DOI: 10.3892/etm.2016.3416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 03/31/2016] [Indexed: 12/21/2022] Open
Abstract
An increase in the use of iodinated contrast media, such as iohexol, iodixanol, iopamidol and iopromide, occasionally causes contrast-induced nephropathy (CIN) in patients undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). The present study aimed to assess the effects of low levels of hemoglobin on the development of CIN in patients with normal renal function following CAG/PCI. A total of 841 consecutive patients undergoing CAG/PCI were divided into two groups: Patients with low levels of hemoglobin (male, <120 g/l; female, <110 g/l; n=156) and normal levels of hemoglobin (male, 120-160 g/l; female, 110-150 g/l; n=685). Multiple logistic regression analysis was performed to identify risk factors for CIN, which developed in 14.7% of patients with low levels of hemoglobin (relative risk, 3.07) and 5% of patients with normal levels of hemoglobin (P<0.01). Independent risk factors for developing CIN in patients with low levels of hemoglobin were a contrast media volume ≥200 ml, diuretic usage, low levels of hemoglobin and diabetes mellitus. For the patients with normal hemoglobin levels, the independent risk factors for developing CIN were a contrast media volume ≥200 ml and diuretic usage. The change in serum creatinine in patients with low levels of hemoglobin was significantly greater compared with patients with normal levels of hemoglobin (7.35±22.60 vs. 1.40±12.00; P<0.01). A similar incidence of developing CIN was observed when patients were administered each type of contrast media: Iohexol, iodixanol, iopamidol and iopromide. The optimal cut-off point at which the serum hemoglobin concentration resulted in a high probability of developing CIN was determined as 111.5 g/l in females and 115.5 g/l in males. In conclusion, low levels of hemoglobin were observed to be an independent risk factor for developing CIN. Patients with reduced hemoglobin levels should, therefore, be closely monitored prior to, and during, the administration of iodinated contrast media.
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Affiliation(s)
- Jinzhong Xu
- Department of Clinical Pharmacy, The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, Zhejiang 317500, P.R. China
- College of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Meiling Zhang
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Yinghua Ni
- Department of Clinical Pharmacy, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310052, P.R. China
| | - Jiana Shi
- Department of Pharmacy, Zhejiang Province People's Hospital, Hangzhou, Zhejiang 31014, P.R. China
| | - Ranran Gao
- Department of Cardiovascular Medicine, The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, Zhejiang 317500, P.R. China
| | - Fan Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, P.R. China
| | - Zhibing Dong
- Department of Cardiovascular Medicine, The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, Zhejiang 317500, P.R. China
| | - Lingjun Zhu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yanlong Liu
- College of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Huimin Xu
- Department of Clinical Pharmacy, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Spagnoli V, Azzalini L, Tadros VX, Picard F, Ly HQ. [Contrast-induced nephropathy: An update]. Ann Cardiol Angeiol (Paris) 2016; 65:87-94. [PMID: 26926776 DOI: 10.1016/j.ancard.2016.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/20/2016] [Indexed: 01/08/2023]
Abstract
Contrast-induced nephropathy (CIN) is common in hospitalized patients. Its occurrence is associated with an increased hospitalization stay and cost, morbidity and mortality. Thus, preventives strategies remain a major issue. Patients that are referred for cardiac catheterization are among the most vulnerable to develop CIN due to their comorbidities. Moreover, in some cases, such preventives measures cannot be introduced due to emergent clinical settings. After a summary regarding the properties of iodinated contrast medium, the aim of this work was to review the definition, pathophysiology, diagnosis and preventive strategies related to CIN.
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Affiliation(s)
- V Spagnoli
- Université de Montréal, Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, 5000 Bélanger street, Montréal, H1T 1C8 QC, Canada
| | - L Azzalini
- Université de Montréal, Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, 5000 Bélanger street, Montréal, H1T 1C8 QC, Canada
| | - V X Tadros
- Université de Montréal, Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, 5000 Bélanger street, Montréal, H1T 1C8 QC, Canada
| | - F Picard
- Université de Montréal, Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, 5000 Bélanger street, Montréal, H1T 1C8 QC, Canada
| | - H Q Ly
- Université de Montréal, Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, 5000 Bélanger street, Montréal, H1T 1C8 QC, Canada.
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Azzalini L, Spagnoli V, Ly HQ. Contrast-Induced Nephropathy: From Pathophysiology to Preventive Strategies. Can J Cardiol 2016; 32:247-55. [DOI: 10.1016/j.cjca.2015.05.013] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 05/04/2015] [Accepted: 05/19/2015] [Indexed: 12/15/2022] Open
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15
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Shams-Eddin Taher H, Hassan AK, Dimitry SR, Mahfouz AK. Predicting contrast induced nephropathy post coronary intervention: A prospective cohort study. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2015.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Effect of Dongchongxiacao (Cordyceps) therapy on contrast-induced nephropathy in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography. J TRADIT CHIN MED 2015; 35:422-7. [PMID: 26427112 DOI: 10.1016/s0254-6272(15)30119-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study the protective effects of Dongchongxiacao (Cordyceps) (DCXC) on contrast-induced nephropathy (CIN) in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography. METHODS A total of 120 patients with type 2 diabetes whose estimated glomerular filtration rater (eGFR) was 60 mL/min · 1.73 in2, were divided randomly into three groups, basic treatment group (n = 41), standard DCXC therapy group (n = 39, 2-g corbrin capsules, 3 times/d, 3 days before and after angiography), and intensive DCXC therapy group (n = 40, 3-g corbrin capsules, 3 times/d, 3 days before and after angiography). Serum creatinine (cr) and eGFR were assessed at the time of admission to hospital, and on days 1, 2 and 3 after angiography. Urine neutrophil-gelatinase-associated-lipo- calin (NGAL), kidney injury molecule-1 (KIM-1) and interleukin-18 (IL-18) were measured before angiography and at day 1 after angiography for all patients. The primary end point was the prevalence of CIN. The secondary end point was a 25% or greater reduction in eGFR. RESULTS CIN occurred in 11 of 120 patients (9.17 %). The prevalence of CIN was lower in the DCXC treatment groups than in the basic treatment group (P < 0.05), with a more significant decrease in the prevalence of CIN in the intensive DCXC therapy group (P < 0.01). Compared with the basic treatment group, a lower proportion of patients in the DCXC treatment groups had an eGFR decrease of 25% or greater (P < 0.05); patients with an eGFR decrease of 25% or greater accounted for an even lower proportion in the intensive DCXC therapy group (P < 0.01). Within 1 day of the procedure, urine levels of KIM-1, NGAL and IL-18 in patients in the intensive DCXC therapy group were lower than those in the basic treatment group and standard therapy group (P < 0.05). CONCLUSION DCXC treatment may protect against CIN in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography, with intensive DCXC therapy being more effective.
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17
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Assessment of estimated GFR and clinical predictors of contrast induced nephropathy among diabetic patients undergoing cardiac catheterization. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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18
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Liu Y, Liu YH, Chen JY, Tan N, Li HL, Luo JF, Chen ZJ, Yu DQ, Li G, Huang WH, Xie NJ, He PC, Yang JQ, Duan CY, Chen SQ, Chen PY. Renal function-adjusted safe contrast volume to prevent contrast-induced nephropathy and poor long-term outcomes in patients with chronic total occlusions undergoing cardiac catheterization. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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19
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Nyman U, Björk J, Bäck SE, Sterner G, Grubb A. Estimating GFR prior to contrast medium examinations—what the radiologist needs to know! Eur Radiol 2015; 26:425-35. [DOI: 10.1007/s00330-015-3842-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/05/2015] [Accepted: 05/11/2015] [Indexed: 11/25/2022]
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20
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Liu Y, Liu YH, Chen JY, Tan N, Zhou YL, Duan CY, Yu DQ, Xie NJ, Li HL, Chen PY. Safe contrast volumes for preventing contrast-induced nephropathy in elderly patients with relatively normal renal function during percutaneous coronary intervention. Medicine (Baltimore) 2015; 94:e615. [PMID: 25816028 PMCID: PMC4553999 DOI: 10.1097/md.0000000000000615] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to evaluate contrast media volume to creatinine clearance (V/CrCl) ratio for predicting contrast-induced nephropathy (CIN) and to determine a safe V/CrCl cut off value to avoid CIN in elderly patients with relatively normal renal function during percutaneous coronary intervention (PCI). We prospectively enrolled 1020 consecutive elderly patients (age ≥65 years) with relative normal renal function (baseline serum creatinine <1.5 mg/dL) undergoing PCI. Receiver operating characteristic (ROC) curves were used to identify the optimal cut off value of V/CrCl for detecting CIN. The predictive value of V/CrCl for CIN was assessed with a multivariate logistic regression. Thirty-nine patients (3.8%) developed CIN. There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001). ROC curve analysis indicated that a V/CrCl ratio of 2.74 was a fair discriminator for CIN (C statistic = 0.68). After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45-7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14-3.38, P = 0.016). A V/CrCl ratio >2.74 was a significant independent predictor of CIN and was independently associated with long-term mortality in elderly patients with relatively normal renal function.
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Affiliation(s)
- Yong Liu
- From the Department of Cardiology (YL, J-yC, NT, Y-lZ, D-qY, N-jX, H-lL), Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences; Department of cardiology, Guangdong General Hospital, Southern Medical University (Y-hL); and Department of Biostatistics (C-yD, P-yC), School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China
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Park HS, Kim CJ, Yi JE, Hwang BH, Kim TH, Koh YS, Park HJ, Her SH, Jang SW, Park CS, Lee JM, Kim HY, Jeon DS, Kim PJ, Yoo KD, Chang K, Jin DC, Seung KB. Contrast Volume/Raw eGFR Ratio for Predicting Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention for Myocardial Infarction. Cardiorenal Med 2015; 5:61-8. [PMID: 25759701 DOI: 10.1159/000369940] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Considering that contrast medium is excreted through the whole kidney in a similar manner to drug excretion, the use of raw estimated glomerular filtration rate (eGFR) rather than body surface area (BSA)-normalized eGFR is thought to be more appropriate for evaluating the risk of contrast-induced acute kidney injury (CI-AKI). METHODS This study included 2,189 myocardial infarction patients treated with percutaneous coronary intervention. Logistic regression analysis was performed to identify the independent risk factors. We used receiver-operating characteristic (ROC) curves to compare the ratios of contrast volume (CV) to eGFR with and without BSA normalization in predicting CI-AKI. RESULTS The area under the curve (AUC) of the ROC curve for the model including all the significant variables such as diabetes mellitus, left ventricular ejection fraction, preprocedural glucose, and the CV/raw modification of diet in renal disease (MDRD) eGFR ratio was 0.768 [95% confidence interval (CI), 0.720-0.816; p < 0.001]. When the CV/raw MDRD eGFR ratio was used as a single risk value, the AUC of the ROC curve was 0.650 (95% CI, 0.590-0.711; p < 0.001). When the CV/MDRD eGFR ratio with BSA normalization ratio was used, the AUC of the ROC curve further decreased to 0.635 (95% CI, 0.574-0.696; p < 0.001). The difference between the two AUCs was significant (p = 0.002). CONCLUSIONS Raw eGFR is a better predictor for CI-AKI than BSA-normalized eGFR.
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Affiliation(s)
- Hoon Suk Park
- Division of Nephrology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Eun Yi
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon Seok Koh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hun-Jun Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Ho Her
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Won Jang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul-Soo Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Min Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee Yeol Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Doo Soo Jeon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Pum-Joon Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Dong Yoo
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Chan Jin
- Division of Nephrology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Bae Seung
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Mavromatis K. The imperative of reducing contrast dose in percutaneous coronary intervention. JACC Cardiovasc Interv 2014; 7:1294-6. [PMID: 25459042 DOI: 10.1016/j.jcin.2014.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/16/2014] [Accepted: 06/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Kreton Mavromatis
- Cardiac Catheterization Laboratory, Atlanta VA Medical Center and Emory University School of Medicine, Atlanta, Georgia.
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Liu YH, Liu Y, Tan N, Chen JY, Chen J, Chen SH, He YT, Ran P, Ye P, Li Y. Predictive value of GRACE risk scores for contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction before undergoing primary percutaneous coronary intervention. Int Urol Nephrol 2013; 46:417-26. [DOI: 10.1007/s11255-013-0598-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/30/2013] [Indexed: 01/03/2023]
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Tan N, Liu Y, Chen JY, Zhou YL, Li X, Li LW, Yu DQ, Chen ZJ, Liu XQ, Huang SJ. Use of the contrast volume or grams of iodine-to-creatinine clearance ratio to predict mortality after percutaneous coronary intervention. Am Heart J 2013; 165:600-8. [PMID: 23537978 DOI: 10.1016/j.ahj.2012.12.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 12/17/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Few studies have assessed the predictive value of the ratio of the contrast media volume or grams of iodine to the creatinine clearance (V/CrCl or g-I/CrCl, respectively) for the risk of contrast-induced nephropathy (CIN) and mortality after percutaneous coronary intervention (PCI). METHODS The association between V/CrCl and mortality was prospectively evaluated in 1,135 consecutive patients undergoing PCI. Cox regression models were used to adjust for the V/CrCl ratio and other confounding factors for risk of death within 1 year. RESULTS Fifty-five patients (4.84%) developed CIN. The 1-year mortality was higher in patients with a V/CrCl ratio >2.62 (g-I/CrCl >0.97) than in others (4.44% vs 0.40%; P < .001). After adjusting for other risk factors, the 1-year mortality risk remained associated with increased V/CrCl ratio. The risk of death was significant for V/CrCl >2.62 (adjusted risk ratio [RR] for death 2.605, 95% CI 1.040-6.529, P = .041), V/CrCl >3.0 (g-I/CrCl >1.11) (adjusted RR 4.338, 95% CI 1.689-11.142, P = .002), and V/CrCl >3.7 (g-I/CrCl >1.37) (adjusted RR 2.557, 95% CI 1.162-5.627, P = .002). CONCLUSION The data further support the prognostic significance of calculating the V/CrCl ratio to predict the relative maximum contrast volume during PCI. Use of a contrast dose determined based on the estimated renal function with a planned V/CrCl ratio <3.7 (g-I/CrCl <1.37) and preferably <2.62 (g-I/CrCl <0.97) might be valuable in reducing the risks of CIN and even death after PCI.
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Li WH, Li DY, Han F, Xu TD, Zhang YB, Zhu H. Impact of anemia on contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary interventions. Int Urol Nephrol 2012; 45:1065-70. [PMID: 23225080 PMCID: PMC3732774 DOI: 10.1007/s11255-012-0340-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 11/16/2012] [Indexed: 12/26/2022]
Abstract
Background The aim of the present study was to assess the influence of anemia on the risk of developing contrast-induced nephropathy after percutaneous coronary angioplasty. Methods Serum creatinine values were measured before and within 48 h after the administration of contrast agents. Contrast-induced nephropathy (CIN) was defined as an increase of ≥0.5 mg/dl or ≥25 % in serum creatinine concentration over baseline within 48 h after administration. Anemia was defined as hemoglobin <120 g/l in women and <130 g/l in men. Results Among the 1,026 patients studied, 32 (3.1 %) developed CIN after procedure. CIN occurred in 6.3 % of the anemic patients and in 2.2 % of the non-anemic patients (P < 0.01). The incidence of CIN increased with decreasing of baseline estimated glomerular filtration rate (eGFR) in both the anemia and non-anemia groups. In patients with baseline eGFR <30 ml/min, a high proportion of both anemic and non-anemic patients experienced CIN (24.6 vs. 17.5 %). When baseline eGFR was 30–59 ml/min, the incidence of CIN in anemic patients was twofold higher than in non-anemic patients (7.9 vs. 3.8 %; P < 0.05). Multivariate logistic regression analysis found that baseline eGFR and baseline hemoglobin were independent predictors of CIN. Conclusion Anemia is associated with a higher incidence of CIN in patients with moderate renal dysfunction. Patients with both preexisting renal insufficiency and anemia are at high risk of CIN. Baseline eGFR and baseline hemoglobin are independent predictors of CIN.
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Affiliation(s)
- Wen-hua Li
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical College, No. 99 Huihai west Road, Xuzhou, 221002, China.
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Thomas D, Giugliano RP. Management of non-ST-segment elevation acute coronary syndrome: comparison of the updated guidelines from North America and Europe. Crit Pathw Cardiol 2012; 11:62-73. [PMID: 22595816 DOI: 10.1097/hpc.0b013e3182563a7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The American College of Cardiology/American Heart Association and the European Society of Cardiology published updated guidelines in 2011 for the management of patients with non-ST-segment elevation acute coronary syndrome. In this article, we highlight the most important new recommendations, review their supporting data, describe differences between the guidelines, and discuss new literature published since the latest guidelines were released. Key updates include detailed guidance regarding early risk stratification, use of coronary computed tomography angiography, selection of initial management strategy, novel antiplatelet agents, and new measures to enhance performance and quality. Major unique recommendations in the European Society of Cardiology guideline include endorsement of ticagrelor inhibitor or prasugrel (after delineation of coronary anatomy) as the first choice of P2Y12 inhibitors, establishment of protocols to identify patients for percutaneous coronary interventions vs. coronary artery bypass surgery, and use of the CRUSADE bleeding score. Meanwhile, unique recommendations in the American College of Cardiology/American Heart Association guideline include administration of prasugrel in selected patients before coronary angiography and consideration of continued dual antiplatelet therapy beyond 15 months after drug-eluting stent placement. Both guidelines include new recommendations endorsing platelet function and genetic testing in selected patients on clopidogrel, renal protection strategies, and less aggressive in patient's glycemic control. As these guidelines represent the most evidence-based approach, health care providers should become familiar with these updated recommendations to ensure optimal treatment of their patients with non-ST-segment elevation acute coronary syndrome.
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Affiliation(s)
- Deepak Thomas
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Hung YM, Lin SL, Hung SY, Huang WC, Wang PYP. Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography. World J Cardiol 2012; 4:157-72. [PMID: 22655164 PMCID: PMC3364502 DOI: 10.4330/wjc.v4.i5.157] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 03/16/2012] [Accepted: 03/23/2012] [Indexed: 02/06/2023] Open
Abstract
Radiocontrast-induced nephropathy (RCIN) is an acute and severe complication after coronary angiography, particularly for patients with pre-existing chronic kidney disease (CKD). It has been associated with both short- and long-term adverse outcomes, including the need for renal replacement therapy, increased length of hospital stay, major cardiac adverse events, and mortality. RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25% above baseline within 48 h after contrast administration. There is no effective therapy once injury has occurred, therefore, prevention is the cornerstone for all patients at risk for acute kidney injury (AKI). There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes. The optimal strategy for preventing RCIN has not yet been established. This review discusses the principal risk factors for RCIN, evaluates and summarizes the evidence for RCIN prophylaxis, and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography.
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Affiliation(s)
- Yao-Min Hung
- Yao-Min Hung, Division of Nephrology, Jiannren Hospital, Kaohsiung 813, Taiwan, China
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Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections? Eur Radiol 2012; 22:1366-71. [DOI: 10.1007/s00330-011-2371-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 12/08/2011] [Accepted: 12/17/2011] [Indexed: 12/28/2022]
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