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Paolucci L, De Micco F, Scarpelli M, Focaccio A, Cavaliere V, Briguori C. Combined strategy of device-based contrast minimization and urine flow rate-guided hydration to prevent acute kidney injury in high-risk patients undergoing coronary interventional procedures. Catheter Cardiovasc Interv 2024. [PMID: 39300825 DOI: 10.1002/ccd.31229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 08/03/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND AND AIMS Contrast-associated acute kidney injury (CA-AKI) is a major complication following coronary procedures. We aimed to evaluate the effectiveness of a combination of urine flow rate-(UFR) guided hydration (RenalGuardTM) and device-based contrast media (CM) reduction (DyeVertTM) in CA-AKI prevention. METHODS Stable high-risk patients undergoing coronary procedures with the use of DyeVertTM and RenalGuardTM were prospectively included (Combined group) and matched with a similar cohort of patients treated only with RenalGuardTM in whom CM volume was controlled by operator-dependent strategies (Control group). CA-AKI was defined as a serum creatinine increase ≥0.3 mg/dL at 48 h. RESULTS Overall, 55 patients were enrolled and matched with comparable controls. Patients in the Combined group were exposed to a lower CM dose (Control: 55 [30-90] mL vs. Combined: 42.1 [24.9-59.4] mL; p = 0.024). A significant interaction was found between treatment allocation and serum creatinine changes (p = 0.048). CA-AKI occurred in five (9.1%) patients in the Combined group and in 14 (25.4%) patients in the Control group (OR 0.29, 95% CI [0.09-0.88]). CONCLUSIONS A combined strategy of device-based CM reduction plus UFR-guided hydration is superior to operator-dependent CM sparing strategies plus UFR-guided hydration in preventing CA-AKI in high-risk patient.
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Affiliation(s)
- Luca Paolucci
- Department of Cardiology, Division of Interventional Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Francesca De Micco
- Department of Cardiology, Division of Interventional Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Mario Scarpelli
- Department of Cardiology, Division of Interventional Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Amelia Focaccio
- Department of Cardiology, Division of Interventional Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Valeria Cavaliere
- Department of Cardiology, Division of Interventional Unit, Mediterranea Cardiocentro, Naples, Italy
- Department of Advanced Biomedical Science, Division of Cardiology, "Federico II" University of Naples, Naples, Italy
| | - Carlo Briguori
- Department of Cardiology, Division of Interventional Unit, Mediterranea Cardiocentro, Naples, Italy
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2
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Briguori C, Quintavalle C, Mariano E, D'Agostino A, Scarpelli M, Focaccio A, Zoccai GB, Evola S, Esposito G, Sangiorgi GM, Condorelli G. Kidney Injury After Minimal Radiographic Contrast Administration in Patients With Acute Coronary Syndromes. J Am Coll Cardiol 2024; 83:1059-1069. [PMID: 38479953 DOI: 10.1016/j.jacc.2024.01.016] [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: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in patients with acute coronary syndromes (ACS) treated by percutaneous coronary intervention. OBJECTIVES Contrast media (CM) volume minimization has been advocated for prevention of AKI. The DyeVert CM diversion system (Osprey Medical, Inc) is designed to reduce CM volume during coronary procedures. METHODS In this randomized, single-blind, investigator-driven clinical trial conducted in 4 Italian centers from February 4, 2020 to September 13, 2022, 550 participants with ACS were randomly assigned in a 1:1 ratio to the following: 1) the contrast volume reduction (CVR) group (n = 276), in which CM injection was handled by the CM diversion system; and 2) the control group (n = 274), in which a conventional manual or automatic injection syringe was used. The primary endpoint was the rate of AKI, defined as a serum creatinine (sCr) increase ≥0.3 mg/dL within 48 hours after CM exposure. RESULTS There were 412 of 550 (74.5%) participants with ST-segment elevation myocardial infarction (211 of 276 [76.4%] in the CVR group and 201 of 274 [73.3%] in the control group). The CM volume was lower in the CVR group (95 ± 30 mL vs 160 ± 23 mL; P < 0.001). Seven participants (1 in the CVR group and 6 in the control group) did not have postprocedural sCr values. AKI occurred in 44 of 275 (16%) participants in the CVR group and in 65 of 268 (24.3%) participants in the control group (relative risk: 0.66; 95% CI: 0.47-0.93; P = 0.018). CONCLUSIONS CM volume reduction obtained using the CM diversion system is effective for prevention of AKI in patients with ACS undergoing invasive procedures. (REnal Insufficiency Following Contrast MEDIA Administration TriaL IV [REMEDIALIV]: NCT04714736).
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Affiliation(s)
- Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy.
| | - Cristina Quintavalle
- Center for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Naples, Italy
| | - Enrica Mariano
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | | | - Mario Scarpelli
- Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy
| | - Amelia Focaccio
- Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy
| | - Giuseppe Biondi Zoccai
- Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy; Center for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Naples, Italy; Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy; Division of Cardiology, Paolo Giaccone University Hospital, Palermo, Italy; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Salvatore Evola
- Division of Cardiology, Paolo Giaccone University Hospital, Palermo, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Division of Cardiology, Federico II University of Naples, Naples, Italy
| | | | - Gerolama Condorelli
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy; Scientific Institute for Research, Hospitalization, and Health Care-Mediterranean Neurological Institute (IRCCS Neuromed), Pozzilli, Italy
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Tran Duc M, Nguyen Quoc T, Nguyen BYT, Vu Quang N, Nguyen Duc N, Nguyen Duc H, Truong Hoai L, Nguyen Hoai V, Phan Kieu H, Nguyen Trung H. Acute Kidney Injury After Percutaneous Coronary Intervention Guided by Intravascular Ultrasound. Cureus 2024; 16:e57164. [PMID: 38681391 PMCID: PMC11056017 DOI: 10.7759/cureus.57164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose We investigated the impact of intravascular ultrasound guidance on reducing the incidence of contrast-induced acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary intervention (PCI). Methods Ninety-nine patients were enrolled in this prospective cohort who were not randomly assigned to angiography-guided percutaneous coronary intervention or intravascular ultrasound-guided percutaneous coronary intervention. The patients were hospitalized at the Vietnam National Heart Institute - Bach Mai Hospital between 2019 and 2020. Acute kidney injury incidence during hospitalization was the primary endpoint. Results A total of 99 patients were divided into two groups: the intravascular ultrasound-guided group (33 participants) and the angiography-guided group (66 participants). The mean ± SD contrast volume of each group was 95.2 ± 37.1 mL and 133.0 ± 36.0 mL for the ultrasound-guided and angiography-guided groups, with P < 0.0001. Intravascular imaging-guided percutaneous coronary intervention (IVUS-guided PCI) was associated with reduced acute kidney injury incidence during hospitalization: 0.0% vs. 12.12% and P = 0.049. Conclusions Intravascular ultrasound is a safe imaging tool that guides percutaneous coronary intervention and significantly reduces the rate of acute kidney injury compared to angiography alone. Patients who have a high chance of experiencing acute kidney injury benefit from using intravascular ultrasound.
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Affiliation(s)
| | | | | | - Ngoc Vu Quang
- C4 Department, Vietnam National Heart Institute, Ha Noi, VNM
| | | | | | | | | | - Hung Phan Kieu
- Anesthesiology and Critical Care, Tam Anh Hospital, Ha Noi, VNM
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4
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Griffiths RI, Bhave A, McGovern AM, Hargens LM, Solid CA, Amin AP. Clinical and economic outcomes of assigning percutaneous coronary intervention patients to contrast-sparing strategies based on the predicted risk of contrast-induced acute kidney injury. J Med Econ 2024; 27:663-670. [PMID: 38632967 DOI: 10.1080/13696998.2024.2334180] [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: 05/30/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Contrast-sparing strategies have been developed for percutaneous coronary intervention (PCI) patients at increased risk of contrast-induced acute kidney injury (CI-AKI), and numerous CI-AKI risk prediction models have been created. However, the potential clinical and economic consequences of using predicted CI-AKI risk thresholds for assigning patients to contrast-sparing regimens have not been evaluated. We estimated the clinical and economic consequences of alternative CI-AKI risk thresholds for assigning Medicare PCI patients to contrast-sparing strategies. METHODS Medicare data were used to identify inpatient PCI from January 2017 to June 2021. A prediction model was developed to assign each patient a predicted probability of CI-AKI. Multivariable modeling was used to assign each patient two marginal predicted values for each of several clinical and economic outcomes based on (1) their underlying clinical and procedural characteristics plus their true CI-AKI status in the data and (2) their characteristics plus their counterfactual CI-AKI status. Specifically, CI-AKI patients above the predicted risk threshold for contrast-sparing were reassigned their no CI-AKI (counterfactual) outcomes. Expected event rates, resource use, and costs were estimated before and after those CI-AKI patients were reassigned their counterfactual outcomes. This entailed bootstrapped sampling of the full cohort. RESULTS Of the 542,813 patients in the study cohort, 5,802 (1.1%) had CI-AKI. The area under the receiver operating characteristic curve for the prediction model was 0.81. At a predicted risk threshold for CI-AKI of >2%, approximately 18.0% of PCI patients were assigned to contrast-sparing strategies, resulting in (/100,000 PCI patients) 121 fewer deaths, 58 fewer myocardial infarction readmissions, 4,303 fewer PCI hospital days, $11.3 million PCI cost savings, and $25.8 million total one-year cost savings, versus no contrast-sparing strategies. LIMITATIONS Claims data may not fully capture disease burden and are subject to inherent limitations such as coding inaccuracies. Further, the dataset used reflects only individuals with fee-for-service Medicare, and the results may not be generalizable to Medicare Advantage or other patient populations. CONCLUSIONS Assignment to contrast-sparing regimens at a predicted risk threshold close to the underlying incidence of CI-AKI is projected to result in significant clinical and economic benefits.
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Affiliation(s)
| | | | | | | | | | - Amit P Amin
- Rush College of Medicine, Rush University Medical Center, Chicago, IL, USA
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Kleb C, Sims OT, Fares M, Ruthmann N, Ansari K, Esfeh JM. Screening Modalities for Coronary Artery Disease in Liver Transplant Candidates: A Review of the Literature. J Cardiothorac Vasc Anesth 2023; 37:2611-2620. [PMID: 37690949 DOI: 10.1053/j.jvca.2023.08.126] [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: 05/21/2023] [Revised: 07/16/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023]
Abstract
Patients with cirrhosis undergoing liver transplant (LT) are at high risk of postoperative cardiopulmonary complications. It is known that patients with coronary artery disease (CAD) have greater rates of post-LT morbidity and mortality than patients without CAD. Thus, identifying significant CAD in LT candidates is of the utmost importance to optimize survival posttransplant. Consensus is lacking on the ideal screening test for CAD in LT candidates. Traditional exercise and many pharmacologic stress tests are impractical and inaccurate in patients with cirrhosis due to their unique physiology. The purpose of this review is to describe different screening modalities for CAD among LT candidates. The background, diagnostic accuracy, and limitations of each screening modality are described to achieve this goal.
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Affiliation(s)
- Cerise Kleb
- Department of Gastroenterology, University of Maryland Medical Center, Baltimore, MD.
| | - Omar T Sims
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Maan Fares
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Nicholas Ruthmann
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Kianoush Ansari
- Department of Diagnostic Radiology, University Hospital Cleveland Medical Center, Cleveland, OH
| | - Jamak Modaresi Esfeh
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH
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Karacsonyi J, Martinez-Parachini JR, Brilakis ES. Acute Kidney Injury Following Percutaneous Coronary Intervention. Am J Cardiol 2023; 206:375-377. [PMID: 37690938 DOI: 10.1016/j.amjcard.2023.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota; Columbia University Irving Medical Center, Division of Cardiology, New York, New York.
| | | | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
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Paolucci L, De Micco F, Bezzeccheri A, Scarpelli M, Esposito G, Airoldi F, Focaccio A, Briguori C. Contrast media volume reduction with the DyeVert TM system to prevent acute kidney injury in stable patients undergoing coronary procedures. Catheter Cardiovasc Interv 2023; 102:655-662. [PMID: 37668067 DOI: 10.1002/ccd.30809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/20/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Contrast associated acute kidney injury (CA-AKI) can lead to an increased risk of adverse events. Contrast media (CM) volume reduction has been advocated as a pivotal strategy to prevent CA-AKI in stable patients undergoing percutaneous coronary procedures. AIMS To compare the effectiveness of CM volume reduction with the DyeVertTM system versus conventional strategy in reducing the risk of CA-AKI. METHODS We prospectively collected data from 136 patients with stable coronary artery disease at high risk of CA-AKI treated with left ventricular end diastolic pressure (LVEDP)- guided hydration and undergoing interventions with the use of the DyeVertTM (Osprey Medical Inc.) system. Patients previously enrolled in the LVEDP-guided hydration arm of the "Renal Insufficiency Following Contrast MEDIA Administration triaL III" (REMEDIAL III) were considered as controls. Propensity score was used to perform 1:1 matching to adjust for major confounders. The primary outcome was the occurrence of CA-AKI, as defined by an absolute increase of creatinine values ≥0.3 mg/dL at 48 h. RESULTS Patients in the DyeVert group were treated with a significant lower CM volume (median: 47.5 vs. 84.0 mL, p < 0.001). The trend in creatinine increase was lower (p = 0.004) and the Δ of creatinine (0-48 h) showed a higher drop (-0.18 vs. -0.10 mg/dL, p = 0.036) in the DyeVert group. The risk of CA-AKI was significantly lower in DyeVert group compared to control group (5.1% vs. 16.8%; odds ratio 0.27, 95% confidence interval [0.12-0.61]). CONCLUSIONS CM volume reduction with the DyeVertTM system seems to be superior to conventional strategies in reducing the occurrence of CA-AKI.
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Affiliation(s)
- Luca Paolucci
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Francesca De Micco
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Andrea Bezzeccheri
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Mario Scarpelli
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Division of Cardiology, "Federico II", University of Naples, Naples, Italy
| | - Flavio Airoldi
- Interventional Cardiology Unit, Istituto di Ricerca a Carattere Scientifico Multimedica MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Amelia Focaccio
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
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Briguori C, Mariano E, D’Agostino A, Scarpelli M, Focaccio A, Evola S, Esposito G, Sangiorgi GM. Contrast Media Volume Control and Acute Kidney Injury in Acute Coronary Syndrome: Rationale and Design of the REMEDIAL IV Trial. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100980. [PMID: 39131657 PMCID: PMC11307588 DOI: 10.1016/j.jscai.2023.100980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/21/2023] [Accepted: 04/04/2023] [Indexed: 08/13/2024]
Abstract
Background Although the pathogenesis of acute kidney injury (AKI) in patients with acute coronary syndrome (ACS) undergoing invasive treatment is multifactorial, the role of iodinated contrast media (CM) has been well established. The DyeVert system (Osprey Medical) is designed to reduce the CM volume during invasive coronary procedures while maintaining fluoroscopic image quality. Objective The aim of the Renal Insufficiency Following Contrast Media Administration Trial IV (REMEDIAL IV) is to test whether the use of the DyeVert system is effective in reducing contrast-associated acute kidney injury (CA-AKI) rate in patients with ACS undergoing urgent invasive procedures. Trial Design Patients with ACS treated by urgent invasive approach will be enrolled. Participants will be randomly assigned into one of the following groups: (1) DyeVert group and (2) control group. In participants enrolled in the DyeVert group, CM injection will be handled by the DyeVert system. On the contrary, in the control group, CM injection will be performed by a conventional manual or automatic injection syringe. In all cases, iobitridol (a low-osmolar, nonionic CM) will be administered. Participants will receive intravenous 0.9% sodium chloride as soon as moved to the catheterization laboratory. The primary end points are CM volume administration and CA-AKI rate (ie, an increase in serum creatinine concentration of ≥0.3 mg/dL within 48 hours after CM exposure). A sample size of at least 522 randomized participants (261 in each group) is needed to demonstrate an 8.5% difference in the CA-AKI rate between the groups (that is, from 19% in the control group to 10.5% in the DyeVert group), with a 2-sided 95% confidence interval and 80% power (P < .05).
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Affiliation(s)
- Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Enrica Mariano
- Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Rome, Italy
| | | | - Mario Scarpelli
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Amelia Focaccio
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Salvatore Evola
- Division of Cardiology, Paolo Giaccone University Hospital, Palermo, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Science, “Federico II” University of Naples, Naples, Italy
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López-Mínguez JR, Martín de Francisco AL, Soler MJ, Hernández F, Moreno R, Pinar E, Sampedro A, Mareque M, Oyagüez I. Cost-effectiveness analysis of dyevert™ Power XT in patients with chronic kidney disease undergoing percutaneous coronary intervention procedures in Spain. Catheter Cardiovasc Interv 2023. [PMID: 37300893 DOI: 10.1002/ccd.30744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the efficiency of Dyevert™ Power XT compared to the standard clinical practice when used for percutaneous coronary interventions (PCI). METHODS A Markov model was developed to estimate, over 3-month cycles and a lifetime time horizon, the cumulative costs and health outcomes (life years gained [LYG] and quality-adjusted life years [QALY]) in a hypothetical cohort of 1,000 patients with chronic kidney disease (CKD) 3b-4 and an average age of 72 years. The incidence of contrast-induced acute kidney injury for these patients is 18.89% in routine practice and 7.78% with Dyevert. QALYs were estimated by applying utilities by health state. Transitions between states and utilities were obtained from the literature. Overall all-cause and state-specific mortality were considered. The total cost (€2,022) estimated with the National Health System perspective included cost of the procedure and of CKD management. The parameters were validated by a panel of experts. A discount rate (3% per year) was applied to costs and outcomes. RESULTS The use of Dyevert yielded more health benefits (34.60 LYG and 5.69 QALYs) compared to the current standard practice (33.11 LYG and 5.38 QALYs). Lifetime cost accumulated at the end of the simulation resulted €30,211/patient with Dyevert and €33,895/patient with current standard clinical practice. CONCLUSIONS The use of Dyevert™ Power XT resulted dominant option, due to its higher effectiveness and lower cost as compared to standard clinical practice and, therefore, a preferred option in patients with CKD stages 3b-4 undergoing PCI in Spain.
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Affiliation(s)
- Jose R López-Mínguez
- Sección de Hemodinámica y Cardiología Intervencionista, Hospital Universitario de Badajoz, Badajoz, España
| | | | - M J Soler
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Felipe Hernández
- Unidad de Hemodinámica y Cardiología Intervencionista, Clínica Universidad de Navarra, Madrid, España
| | - Raul Moreno
- Unidad de Cardiología Intervencionista, Hospital Universitario La Paz, Madrid, España
| | - Eduardo Pinar
- Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - M Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| | - I Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
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10
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Griffiths RI, Cavalcante R, McGovern AM, Bhave A, Hargens LM, Solid CA, Amin AP. Cost to Medicare of acute kidney injury in percutaneous coronary intervention. Am Heart J 2023; 262:20-28. [PMID: 37015308 DOI: 10.1016/j.ahj.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Acute kidney injury (AKI), including contrast-induced AKI (CI-AKI), is an important complication of percutaneous coronary intervention (PCI), resulting in short- and long-term adverse clinical outcomes. While prior research has reported an increased cost burden to hospitals from CI-AKI, the incremental cost to payers remains unknown. Understanding this incremental cost may inform decisions and even policy in the future. The objective of this study was to estimate the short- and long-term cost to Medicare of AKI overall, and specifically CI-AKI, in PCI. METHODS Patients undergoing inpatient PCI between January 2017 and June 2020 were selected from Medicare 100% fee-for-service data. Baseline clinical characteristics, PCI lesion/procedural characteristics, and AKI/CI-AKI during the PCI admission, were identified from diagnosis and procedure codes. Poisson regression, generalized linear modelling, and longitudinal mixed effects modelling, in full and propensity-matched cohorts, were used to compare PCI admission length of stay (LOS) and cost (Medicare paid amount inflated to 2022 US$), as well as total costs during 1-year following PCI, between AKI and non-AKI patients. RESULTS The study cohort included 509,039 patients, of whom 104,033 (20.4%) were diagnosed with AKI and 9,691 (1.9%) with CI-AKI. In the full cohort, AKI was associated with +4.12 (95% confidence interval = 4.10, 4.15) days index PCI admission LOS, +$11,313 ($11,093, $11,534) index admission costs, and +$14,800 ($14,359, $15,241) total 1-year costs. CI-AKI was associated with +3.03 (2.97, 3.08) days LOS, +$6,566 ($6,148, $6,984) index admission costs, and +$13,381 ($12,118, $14,644) cumulative 1-year costs (all results are adjusted for baseline characteristics). Results from the propensity-matched analyses were similar. CONCLUSIONS AKI, and specifically CI-AKI, during PCI is associated with significantly longer PCI admission LOS, PCI admission costs, and long-terms costs.
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Affiliation(s)
| | | | | | | | | | | | - Amit P Amin
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
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11
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Irannejad K, Vakhshoori M, Khoubyari R, Movahed MR. Contrast removal from coronary sinus for prevention of contrast-induced nephropathy: a review. Future Cardiol 2023; 19:283-299. [PMID: 37466075 DOI: 10.2217/fca-2023-0034] [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: 07/20/2023] Open
Abstract
The occurrence of contrast-induced-nephropathy (CIN) is related to the amount of contrast administration. Any removal of contrast from systemic circulation before reaching the kidneys might be beneficial using a device that removes contrast from a coronary sinus (CS). This manuscript aims to review the available literature regarding contrast removal from CS during coronary angiography or intervention for the prevention of CIN.
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Affiliation(s)
| | | | - Rostam Khoubyari
- University of Arizona Sarver Heart Center, Tucson, AZ 85724, USA
| | - Mohammad Reza Movahed
- University of Arizona Sarver Heart Center, Tucson, AZ 85724, USA
- University of Arizona, College of Medicine, Phoenix, AZ 85004, USA
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12
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Hennessey B, Shabbir A, Travieso A, Gonzalo N, Escaned J. Procedural and Technological Innovations Facilitating Ultra-low Contrast Percutaneous Coronary Interventions. Interv Cardiol 2023; 18:e09. [PMID: 37387711 PMCID: PMC10301683 DOI: 10.15420/icr.2022.32] [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: 09/27/2022] [Accepted: 12/10/2022] [Indexed: 03/31/2023] Open
Abstract
Ultra-low-dose contrast percutaneous coronary intervention (PCI) is a valuable approach in selected complex high-risk patients with renal failure. One of the objectives of ultra-low contrast PCI is to decrease the probability of developing postprocedural contrast-induced nephropathy (CIN), which predominately affects patients with baseline renal dysfunction. CIN is associated with poor clinical outcomes and increased healthcare-related costs. Another two clinical scenarios in which reduced dependence on contrast administration by the operator may contribute to improved safety are PCI in complex, high-risk indicated patients and in shock. In this review, we discuss the procedural techniques and recent technological innovations that enable ultra-low-dose contrast PCI to be performed in the cardiac cath lab.
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Affiliation(s)
- Breda Hennessey
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISSC, Complutense Universidad de Madrid Madrid, Spain
| | - Asad Shabbir
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISSC, Complutense Universidad de Madrid Madrid, Spain
| | - Alejandro Travieso
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISSC, Complutense Universidad de Madrid Madrid, Spain
| | - Nieves Gonzalo
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISSC, Complutense Universidad de Madrid Madrid, Spain
| | - Javier Escaned
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISSC, Complutense Universidad de Madrid Madrid, Spain
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13
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Sůva M, Kala P, Poloczek M, Kaňovský J, Štípal R, Radvan M, Hlasensky J, Hudec M, Brázdil V, Řehořová J. Contrast-induced acute kidney injury and its contemporary prevention. Front Cardiovasc Med 2022; 9:1073072. [PMID: 36561776 PMCID: PMC9763312 DOI: 10.3389/fcvm.2022.1073072] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
The complexity and application range of interventional and diagnostic procedures using contrast media (CM) have recently increased. This allows more patients to undergo procedures that involve CM administration. However, the intrinsic CM toxicity leads to the risk of contrast-induced acute kidney injury (CI-AKI). At present, effective therapy of CI-AKI is rather limited. Effective prevention of CI-AKI therefore becomes crucially important. This review presents an in-depth discussion of CI-AKI incidence, pathogenesis, risk prediction, current preventive strategies, and novel treatment possibilities. The review also discusses the difference between CI-AKI incidence following intraarterial and intravenous CM administration. Factors contributing to the development of CI-AKI are considered in conjunction with the mechanism of acute kidney damage. The need for ultimate risk estimation and the prediction of CI-AKI is stressed. Possibilities of CI-AKI prevention is evaluated within the spectrum of existing preventive measures aimed at reducing kidney injury. In particular, the review discusses intravenous hydration regimes and pre-treatment with statins and N-acetylcysteine. The review further focuses on emerging alternative imaging technologies, alternative intravascular diagnostic and interventional procedures, and new methods for intravenous hydration guidance; it discusses the applicability of those techniques in complex procedures and their feasibility in current practise. We put emphasis on contemporary interventional cardiology imaging methods, with a brief discussion of CI-AKI in non-vascular and non-cardiologic imaging and interventional studies.
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Affiliation(s)
- Marek Sůva
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia,*Correspondence: Petr Kala,
| | - Martin Poloczek
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jan Kaňovský
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Roman Štípal
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Martin Radvan
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jiří Hlasensky
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Martin Hudec
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Vojtěch Brázdil
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jitka Řehořová
- Department of Internal Medicine and Gastroenterology, University Hospital, Brno, Czechia
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14
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Safley DM, Salisbury AC, Tsai TT, Secemsky EA, Kennedy KF, Rogers RK, Latif F, Shammas NW, Garcia L, Cavender MA, Rosenfield K, Prasad A, Spertus JA. Acute Kidney Injury Following In-Patient Lower Extremity Vascular Intervention: From the National Cardiovascular Data Registry. JACC Cardiovasc Interv 2021; 14:333-341. [PMID: 33541543 DOI: 10.1016/j.jcin.2020.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The authors analyzed data from the NCDR (National Cardiovascular Data Registry) PVI Registry and defined acute kidney injury (AKI) as increased creatinine of ≥0.3 mg/dl or 50%, or a new requirement for dialysis after PVI. BACKGROUND AKI is an important and potentially modifiable complication of peripheral vascular intervention (PVI). The incidence, predictors, and outcomes of AKI after PVI are incompletely characterized. METHODS A hierarchical logistic regression risk model using pre-procedural characteristics associated with AKI was developed, followed by bootstrap validation. The model was validated with data submitted after model creation. An integer scoring system was developed to predict AKI after PVI. RESULTS Among 10,006 procedures, the average age of patients was 69 years, 58% were male, and 52% had diabetes. AKI occurred in 737 (7.4%) and was associated with increased in-hospital mortality (7.1% vs. 0.7%). Reduced glomerular filtration rate, hypertension, diabetes, prior heart failure, critical or acute limb ischemia, and pre-procedural hemoglobin were independently associated with AKI. The model to predict AKI showed good discrimination (optimism corrected c-statistic = 0.68) and calibration (corrected slope = 0.97, intercept of -0.07). The integer point system could be incorporated into a useful clinical tool because it discriminates risk for AKI with scores ≤4 and ≥12 corresponding to the lower and upper 20% of risk, respectively. CONCLUSIONS AKI is not rare after PVI and is associated with in-hospital mortality. The NCDR PVI AKI risk model, including the integer scoring system, may prospectively estimate AKI risk and aid in deployment of strategies designed to reduce risk of AKI after PVI.
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Affiliation(s)
- David M Safley
- Cardiology Department, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, USA.
| | - Adam C Salisbury
- Cardiology Department, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Thomas T Tsai
- Interventional Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Eric A Secemsky
- Vascular Intervention, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kevin F Kennedy
- Cardiology Department, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - R Kevin Rogers
- Vascular Medicine & Intervention, University of Colorado, Aurora, Colorado, USA
| | - Faisal Latif
- Interventional Cardiology, University of Oklahoma & VA Medical Center, Oklahoma City, Oklahoma, USA
| | | | - Lawrence Garcia
- Section of Interventional Cardiology, Tufts University School of Med, Boston, Massachusetts, USA
| | - Matthew A Cavender
- Interventional Cardiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kenneth Rosenfield
- Interventional Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anand Prasad
- Cardiovascular Disease, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - John A Spertus
- Cardiology Department, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, USA
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15
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Tarantini G, Cardaioli F. New DyeVert system for contrast media volume reduction in percutaneous procedures: "Make kidney safe again". Catheter Cardiovasc Interv 2021; 98:85-86. [PMID: 34219375 DOI: 10.1002/ccd.29810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua Medical School, Padua, Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua Medical School, Padua, Italy
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16
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Liu X, Zhang P, Zhang J, Zhang X, Yang S, Fu N. The Preventive Effect of Alprostadil on the Contrast-Induced Nephropathy of Coronary Heart Disease Treated by Percutaneous Coronary Intervention in Moderate and High-Risk Population Stratified by Mehran Score. Angiology 2021; 73:33-41. [PMID: 34098771 DOI: 10.1177/00033197211015540] [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: 11/16/2022]
Abstract
The Mehran risk score (MRS) was used to classify patients with coronary heart disease and evaluate the preventive effect of alprostadil on contrast-induced nephropathy (CIN) after percutaneous coronary intervention. The patients (n = 1146) were randomized into an alprostadil and control group and then divided into 3 groups on the basis of the MRS: low-risk, moderate-risk, and high-risk groups. The primary end point was the occurrence of CIN (alprostadil + hydration vs simple hydration treatment); secondary end points included serum creatinine, blood urea nitrogen, creatinine clearance rate, cystatin C, interleukin-6, C-reactive protein, proteinuria, and differences in the incidence of major adverse events. In the low-risk, moderate-risk, and high-risk groups, the incidence of CIN in the control and alprostadil group was 2.9 versus 2.6% (P = .832), 11.4 versus 4.9% (P = .030), 19.1 versus 7.7% (P = .041), respectively. Multivariate logistic regression analysis showed that alprostadil treatment was a favorable protective factor for moderate-risk and high-risk CIN patients (OR = 0.343, 95% CI: 0.124-0.951, P = .040). Alprostadil can be used as a preventive treatment for moderate- and high-risk CIN patients classified by the MRS. The reduction of CIN by alprostadil may be related to an anti-inflammatory effect.
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Affiliation(s)
- Xiaogang Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Peng Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jing Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Xue Zhang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Shicheng Yang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Naikuan Fu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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17
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Misawa T, Sugiyama T, Kanaji Y, Hoshino M, Yamaguchi M, Hada M, Nagamine T, Nogami K, Yasui Y, Terada N, Kuramochi T, Usui E, Lee T, Yonetsu T, Sasano T, Kakuta T. Effect of contrast medium versus low-molecular-weight dextran for intracoronary optical coherence tomography in renal insufficiency. Int J Cardiovasc Imaging 2021; 37:2603-2615. [PMID: 33880712 DOI: 10.1007/s10554-021-02245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Low-molecular-weight dextran (LMWD) is considered a safe alternative to contrast media to displace blood during optical coherence tomography (OCT) imaging, but concerns remain. The purpose of this study was to investigate whether using LMWD for OCT protects against kidney injury in patients with renal insufficiency compared with contrast media. We retrospectively identified 474 patients with renal insufficiency (estimated glomerular filtration rate < 60 ml/min/1.73 m2) who underwent OCT during coronary angiography or percutaneous coronary intervention; 110 patients with LMWD plus contrast medium (LMWD group) and 364 patients with contrast medium exclusively (Contrast group). We evaluated differences between the two groups and performed propensity score-matched subgroup comparisons. Compared with the Contrast group, the LMWD group had worse baseline renal function, higher prevalence of diabetes mellitus and percutaneous coronary intervention history, higher C-reactive protein and N-terminal pro B-type natriuretic peptide levels, lower hemoglobin levels, and lower left ventricular ejection fraction. The median total volume of contrast medium in the Contrast group was 230.0 ml vs. 61.8 ml of LMWD in addition to 164.0 ml of contrast medium in the LMWD group. Renal function was consistently impaired in the LMWD group within 5 days, at 1-month, and 1-year follow-up (P < 0.001). Two propensity score-matched analyses adjusted for either total volume used or contrast media volume consistently indicated a trend toward worsening renal function in the LMWD group at the 1-year follow-up. No protective benefit for renal function from using LMWD instead of contrast media for OCT was observed in patients with renal insufficiency.
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Affiliation(s)
- Toru Misawa
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masao Yamaguchi
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tatsuhiro Nagamine
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kai Nogami
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Yumi Yasui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Noriko Terada
- Department of Clinical Laboratory, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Tatsuhiko Kuramochi
- Department of Clinical Laboratory, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan.
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18
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Misawa T, Sugiyama T, Kanaji Y, Hoshino M, Yamaguchi M, Hada M, Nagamine T, Nogami K, Yasui Y, Usui E, Lee T, Yonetsu T, Sasano T, Kakuta T. Low-molecular-weight dextran for optical coherence tomography may not be protective against kidney injury in patients with renal insufficiency. World J Nephrol 2021; 10:8-20. [PMID: 33816153 PMCID: PMC8008983 DOI: 10.5527/wjn.v10.i2.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Low-molecular-weight dextran (LMWD) is considered a safe alternative to contrast media for blood displacement during optical coherence tomography (OCT) imaging.
AIM To investigate whether the use of LMWD for OCT is protective against kidney injury in patients with advanced renal insufficiency.
METHODS In this retrospective cohort study, we identified 421 patients with advanced renal insufficiency (estimated glomerular filtration rate < 45 mL/min/1.73 m2) who underwent coronary angiography or percutaneous coronary intervention; 79 patients who used additional LMWD for OCT imaging (LMWD group) and 342 patients who used contrast medium exclusively (control group). We evaluated the differences between these two groups and performed a propensity score-matched subgroup comparison.
RESULTS The median total volume of contrast medium was 133.0 mL in the control group vs 140.0 mL in the LMWD group. Although baseline renal function was not statistically different between these two groups, the LMWD group demonstrated a strong trend toward the progression of renal insufficiency as indicated by the greater change in serum creatinine level during the 1-year follow-up compared with the control group. Patients in the LMWD group experienced worsening renal function more frequently than patients in the control group. Propensity score matching adjusted for total contrast media volume consistently indicated a trend toward worsening renal function in the LMWD group at the 1-year follow-up. Delta serum creatinine at 1-year follow-up was significantly greater in the LMWD group than that in the control group [0.06 (-0.06, 0.29) vs -0.04 (-0.23, 0.08) mg/dL, P = 0.001], despite using similar contrast volume.
CONCLUSION OCT using LMWD may not be protective against worsening renal function in patients with advanced renal insufficiency.
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Affiliation(s)
- Toru Misawa
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Masao Yamaguchi
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Tatsuhiro Nagamine
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Kai Nogami
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Yumi Yasui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
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19
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Boccalandro F, Shreyder K, Harmon L, Dhindsa M, Fahim T, Sheikh S. Five-year follow-up of patients with radio-contrast-induced acute renal injury. Can intravenous sodium-bicarbonate improve long-term outcomes? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 31:61-68. [PMID: 33250404 DOI: 10.1016/j.carrev.2020.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND/PURPOSE Radiocontrast-induced acute kidney injury (RAKI) is a frequent complication during angiography and is associated with adverse prognosis. Most of the studies evaluating the long-term outcome of patients with RAKI are based on institutional registries. This is the first prospective study to evaluate the 5-year outcomes of patients with RAKI, and assess the effect of sodium bicarbonate (SB) in the long-term outcomes of patients with chronic kidney disease (CKD) undergoing non-emergent coronary angiography. MATERIALS/METHODS 382 CKD stage III-IV patients undergoing elective non-emergent coronary angiography were randomized to SB (n = 192) or normal saline (NS) solution (n = 190). Incidence of RAKI, in-hospital, 1- and 5-year mortality and renal replacement therapy (RRT), and 5-year major adverse renal and cardiovascular events (MARCE) were compared between groups. Outcomes of patient with and without RAKI were compared after five-years of prospective follow-up. Multivariate predictors of RAKI and death at 5-years were determined. RESULTS The use of SB did not improve the incidence of RAKI, in-hospital outcomes, survival, and freedom from RRT or MARCE after 5-years of follow-up. Patients that developed RAKI had a significantly higher mortality at 1-year [8.9% Vs. 1.2%] and 5-years (36% Vs. 11%) (P < 0.01). CONCLUSIONS Hydration with SB showed no benefit compared to NS in preventing RAKI. The use of SB was not superior to NS after 5-years of follow-up regarding MARCE, survival or freedom of RRT. Five-year mortality among patients who developed RAKI remains high, and further research is needed to find the best preventive strategy for this high-risk group of patients. SUMMARY Radiocontrast-induced acute-kidney-injury (RAKI) is associated with poor long-term outcomes in observational and short-term studies. Hydration with sodium bicarbonate (SB) had been evaluated in the prevention of RAKI; but its long-term effect has not been evaluated. We randomized 382 high high-risk patients undergoing coronary angiography to SB or normal saline following them for five years. SB showed no benefit in preventing RAKI, decreasing major adverse renal and cardiovascular events, improving survival or freedom from dialysis after 5-years. This is the first study to follow patients with RAKI for a period of 5-years, showing a significantly higher mortality in this group of patients.
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Affiliation(s)
- Fernando Boccalandro
- ProCare/Odessa Heart Institute & Permian Research Foundation, Odessa, TX, United States of America; Texas Tech University Health Sciences Center, Department of Internal Medicine, Odessa, TX, United States of America.
| | - Katherine Shreyder
- Lahey Hospital and Medical Center, Department of Cardiovascular Medicine, Tufts University School of Medicine, Burlington, MA, United States of America
| | - Laura Harmon
- University of Colorado School of Medicine, Department of Surgery, Denver, CO, United States of America
| | - Mandeep Dhindsa
- Community Medical Center, Stockton, CA, United States of America
| | - Tallat Fahim
- Kaiser Permanente - Bellevue Medical Center. Tacoma, WA, United States of America
| | - Samia Sheikh
- Fresenius Medical Center, Inidanapolis, IN, United States of America
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20
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Zhang F, Lu Z, Wang F. Advances in the pathogenesis and prevention of contrast-induced nephropathy. Life Sci 2020; 259:118379. [PMID: 32890604 DOI: 10.1016/j.lfs.2020.118379] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/18/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022]
Abstract
With the increasing application of medical imaging contrast materials, contrast-induced nephropathy has become one of the leading causes of iatrogenic renal insufficiency. The underlying mechanism is associated with renal medullary hypoxia, direct toxicity of contrast agents, oxidative stress, apoptosis, immune/inflammation and epigenetic regulation in contrast-induced nephropathy. Up to date, there is no effective therapy for contrast-induced nephropathy, and thus risk predication and effective preventive strategies are keys to reduce the occurrence of contrast-induced nephropathy. It was found that the proper use of contrast medium, personalized hydration, and high-dose statins may reduce the occurrence of contrast-induced nephropathy, while antioxidants have not shown significant therapeutic benefits. Additionally, the role of remote ischemia preconditioning and vasodilators in the prevention of contrast-induced nephropathy needs further study. This review aims to discuss the incidence, pathogenesis, risk prediction, and preventive strategies for contrast-induced nephropathy.
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Affiliation(s)
- Fangfei Zhang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Zeyuan Lu
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Feng Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
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21
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Zhang X, Zhang P, Yang S, Li W, Men X, Fu N. Preventive effect of trimetazidine on contrast-induced nephropathy undergoing percutaneous coronary intervention in elderly moderate and high risk diabetics stratified by mehran score. Perfusion 2020; 36:491-500. [PMID: 32838661 DOI: 10.1177/0267659120952057] [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: 11/16/2022]
Abstract
BACKGROUND The aim of this research was to use the Mehran risk score to classify elderly diabetics with coronary heart disease to assess the preventive effect of trimetazidine on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in different risk population. METHODS An uncompromised of 760 elderly diabetics that went through PCI were included in this research. The patients were first divided into three groups in the light of MRS: low-risk, moderate-risk, and high-risk group, then randomized into trimetazidine group and the control group respectively. The first endpoint was the amount of CIN, which is described as a rise in serum creatinine levels by ⩾44.2 μmol/L or ⩾25% ratio within 48 or 72 hours after medication. Second endpoint included differences in creatinine clearance rate (CrCl), blood urea nitrogen (BUN), serum creatinine (Scr), cystatin-C (Cys-C), and the incidence of major adverse events after administration. RESULTS In the three groups, the incidence of CIN in trimetazidine and control group was 5.0% versus 4.9%(χ2 = 0.005, p > 0.05), 8.0% versus 18.0% (χ2 = 7.685, p < 0.05), 10.4% versus 27.1% (χ2 = 4.376, p < 0.05), respectively. The multivariable logistic regression result demonstrated that trimetazidine intervention was a profitable element of CIN in moderate and high-risk groups (OR = 0.294, 95% CI 0.094-0.920, p = 0.035). CONCLUSION Our study confirmed that trimetazidine can be considered for preventive treatment of CIN occurrence in elderly diabetics with moderate and high-risk population, while there is no obvious advantage compared with hydration therapy in low-risk patients.
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Affiliation(s)
- Xue Zhang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Peng Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Shicheng Yang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wenyuan Li
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Xiuzhen Men
- Department of Catheter lab, Dongying Second People's Hospital, Shandong,China
| | - Naikuan Fu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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22
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Briguori C, Golino M, Porchetta N, Scarpelli M, De Micco F, Rubino C, Focaccio A, Signoriello G. Impact of a contrast media volume control device on acute kidney injury rate in patients with acute coronary syndrome. Catheter Cardiovasc Interv 2020; 98:76-84. [DOI: 10.1002/ccd.29136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/06/2020] [Accepted: 06/27/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Carlo Briguori
- Interventional Cardiology Unit Mediterranea Cardiocentro Naples Italy
| | - Marco Golino
- Interventional Cardiology Unit Mediterranea Cardiocentro Naples Italy
| | - Nicola Porchetta
- Interventional Cardiology Unit Mediterranea Cardiocentro Naples Italy
| | - Mario Scarpelli
- Interventional Cardiology Unit Mediterranea Cardiocentro Naples Italy
| | | | - Carmine Rubino
- Interventional Cardiology Unit Mediterranea Cardiocentro Naples Italy
| | - Amelia Focaccio
- Interventional Cardiology Unit Mediterranea Cardiocentro Naples Italy
| | - Giuseppe Signoriello
- Department of Mental Health and Preventive Medicine Second University of Naples Naples Italy
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23
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Nanayakkara S, Kaye DM. Device Based Approaches to the Prevention of Contrast-Induced Acute Kidney Injury. Interv Cardiol Clin 2020; 9:395-401. [PMID: 32471679 DOI: 10.1016/j.iccl.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Contrast-induced acute kidney injury is not uncommon after percutaneous coronary intervention, particularly in high-risk patients. Pharmacologic approaches have not demonstrated significant benefit, and numerous device-based approaches exist targeting a variety of pathways. In this review, we summarize the most recent interventions and the evidence behind them.
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Affiliation(s)
- Shane Nanayakkara
- Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Wellington Road, Clayton, Melbourne, VIC 3168, Australia; Heart Failure Research Group, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia. https://twitter.com/DrNanayakkara
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Wellington Road, Clayton, Melbourne, VIC 3168, Australia; Heart Failure Research Group, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.
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24
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Bugani G, Ponticelli F, Giannini F, Gallo F, Gaudenzi E, Laricchia A, Fisicaro A, Cimaglia P, Mangieri A, Gardi I, Colombo A. Practical guide to prevention of contrast-induced acute kidney injury after percutaneous coronary intervention. Catheter Cardiovasc Interv 2020; 97:443-450. [PMID: 31967390 DOI: 10.1002/ccd.28740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/12/2019] [Accepted: 01/11/2020] [Indexed: 11/06/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) represents a common but serious complication of percutaneous coronary interventions (PCI)-and in general of all those examinations requiring iodinated contrast injection-which affects not only renal function but also long-term prognosis. While several prophylactic approaches were designed in order to prevent CI-AKI, most failed to demonstrate clear benefits in randomized trials, and their implementation is therefore discouraged in clinical practice. The most notorious examples include pre-procedural bicarbonate or N-acetylcysteine, and preprocedural withdrawal of ACE inhibitors/Angiotensin receptor blockers. Those strategies that were instead demonstrated effective include the appropriate use of preprocedural hydration, reduction in contrast volume utilization, adoption of techniques for zero- or ultra-low-contrast procedures, and pharmacological treatments with statins. In this brief review, we summarize the main preventive strategies into brief and pragmatic recommendations designed to improve everyday clinical practice.
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Affiliation(s)
- Giulia Bugani
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Francesco Ponticelli
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Gallo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy.,Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Eleonora Gaudenzi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Fisicaro
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Paolo Cimaglia
- Cardiology Department, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Ilja Gardi
- Cardiology Department, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.,Emo GVM Centro Cuore Columbus, Interventional Cardiology Unit, Milan, Italy
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25
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Stys A, Gedela M, Bhatnagar U, Petrasko M, Dawoud H, Malinski T, Stys T. A prospective study of contrast preservation using ultra-low contrast delivery technique versus standard automated contrast injector system in coronary procedures. Indian Heart J 2019; 71:297-302. [PMID: 31779856 PMCID: PMC6890984 DOI: 10.1016/j.ihj.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/29/2019] [Accepted: 09/01/2019] [Indexed: 12/22/2022] Open
Abstract
Background We aimed to assess the decrease in contrast media volume (CMV) with ultra-low contrast delivery technique (ULCD) developed at our institution versus the usual automated contrast injector system (ACIS) contrast delivery in coronary procedures. Methods We analyzed the amount of contrast given in the consecutive 204 patients of the operators who use ULCD technique versus consecutive 200 patients of the other operators who use ACIS without ULCD technique for coronary angiograms and/or percutaneous coronary interventions (PCIs) from May 2017 to July 2018 at our center. We calculated the mean CMV between these groups. Results We observed a significant reduction in mean CMV with ULCD technique versus standard ACIS, respectively: angiogram 24.8 ± 15.8 mL (n = 194) vs 42.3 ± 25.1 mL (n = 200) (p < 0.0001); PCI 23.5 ± 19.7 mL (n = 52) vs 48.2 ± 30.8 mL (n = 16) (p < 0.0070); angiogram with ad hoc PCI 53.4 ± 32.1 mL (n = 23) vs 89.7 ± 35.6 mL (n = 16) (p < 0.0024); and overall angiogram and PCI 27.4 ± 20.5 mL (n = 204) vs 44.9 ± 28.0 mL (n = 181) (p < 0.0001). Conclusion Our study showed a highly significant reduction in CMV using ULCD technique compared to standard ACIS contrast delivery in coronary invasive procedures. Even in the standard ACIS arm, CMV was significantly lower than values reported in literature, possibly due to operators' bias toward contrast preservation.
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Affiliation(s)
- Adam Stys
- Sanford Heart Hospital, Sanford Cardiovascular Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, 57105, USA
| | - Maheedhar Gedela
- Sanford Heart Hospital, Sanford Cardiovascular Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, 57105, USA.
| | - Udit Bhatnagar
- Sanford Heart Hospital, Sanford Cardiovascular Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, 57105, USA
| | - Marian Petrasko
- Sanford Heart Hospital, Sanford Cardiovascular Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, 57105, USA
| | - Hazem Dawoud
- Nanomedical Research Laboratory, Ohio University, Athens, OH, 45701, USA
| | - Tadeusz Malinski
- Nanomedical Research Laboratory, Ohio University, Athens, OH, 45701, USA
| | - Tomasz Stys
- Sanford Heart Hospital, Sanford Cardiovascular Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, 57105, USA
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26
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Morcos R, Kucharik M, Bansal P, Al Taii H, Manam R, Casale J, Khalili H, Maini B. Contrast-Induced Acute Kidney Injury: Review and Practical Update. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819878680. [PMID: 31700251 PMCID: PMC6826945 DOI: 10.1177/1179546819878680] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is an important consideration in patients undergoing cardiac catheterization. There has been a continuous strive to decrease morbidity and improve procedural safety. This review will address the pathophysiology, predictors, and clinical management of CI-AKI with a concise overview of the pathophysiology and a suggested association with left atrial appendage closure. Minimizing contrast administration and intravenous fluid hydration are the cornerstones of an effective preventive strategy. A few adjunctive pharmacotherapies hold promise, but there are no consensus recommendations on prophylactic therapies.
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Affiliation(s)
- Ramez Morcos
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Michael Kucharik
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Pirya Bansal
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, FL, USA
| | - Haider Al Taii
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, FL, USA
| | - Rupesh Manam
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Joel Casale
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Houman Khalili
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, FL, USA.,Tenet Healthcare Corporation, Boca Raton, FL, USA
| | - Brijeshwar Maini
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, FL, USA.,Tenet Healthcare Corporation, Boca Raton, FL, USA
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27
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Procedural Strategies to Reduce the Incidence of Contrast-Induced Acute Kidney Injury During Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:1877-1888. [DOI: 10.1016/j.jcin.2019.04.055] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 11/23/2022]
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28
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Bruno RR, Nia AM, Wolff G, Erkens R, Kelm M, Westenfeld R, Jung C. Early clinical experiences with a novel contrast volume reduction system during invasive coronary angiography. IJC HEART & VASCULATURE 2019; 23:100377. [PMID: 31193344 PMCID: PMC6525317 DOI: 10.1016/j.ijcha.2019.100377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/01/2019] [Accepted: 05/05/2019] [Indexed: 01/01/2023]
Affiliation(s)
| | | | | | | | | | | | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany
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29
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Guedeney P, Sorrentino S, Vogel B, Baber U, Claessen BE, Mehran R. Assessing and minimizing the risk of percutaneous coronary intervention in patients with chronic kidney disease. Expert Rev Cardiovasc Ther 2018; 16:825-835. [DOI: 10.1080/14779072.2018.1526082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Paul Guedeney
- The Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA
- Department of Cardiology, ACTION Study Group, Sorbonne Université - Univ Paris 06 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Paris, France
| | - Sabato Sorrentino
- The Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Birgit Vogel
- The Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA
| | - Usman Baber
- The Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA
| | - Bimmer E. Claessen
- The Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA
| | - Roxana Mehran
- The Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, New York, USA
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30
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Chambers CE. Risk Reduction of Acute Kidney Injury From Iodinated Contrast. JACC Cardiovasc Interv 2018; 11:1611-1613. [DOI: 10.1016/j.jcin.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/01/2018] [Indexed: 10/28/2022]
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