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Ho T, Vallabhajosyula S, Nagaraja V. Renal Transplantation Offers Long-Term Cardiac Protection With a Potential for Further Improvement. Heart Lung Circ 2024; 33:913-914. [PMID: 39032975 DOI: 10.1016/j.hlc.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Affiliation(s)
- Tiffany Ho
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Saraschandra Vallabhajosyula
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Lifespan Cardiovascular Institute, Providence, RI, USA
| | - Vinayak Nagaraja
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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2
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Wu EB, Kalyanasundaram A, Brilakis ES, Mashayekhi K, Tsuchikane E. Global Consensus Recommendations on Improving the Safety of Chronic Total Occlusion Interventions. Heart Lung Circ 2024; 33:915-931. [PMID: 38839467 DOI: 10.1016/j.hlc.2023.11.030] [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: 01/05/2023] [Revised: 09/18/2023] [Accepted: 11/06/2023] [Indexed: 06/07/2024]
Abstract
Safety is of critical importance to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). This global consensus statement provides guidance on how to optimise the safety of CTO) PCI, addressing the following 12 areas: 1. Set-up for safe CTO PCI; 2. Guide catheter--associated vessel injuries; 3. Hydraulic dissection, extraplaque haematoma expansion, and aortic dissections; 4. Haemodynamic collapse during CTO PCI; 5. Side branch occlusion; 6. Perforations; 7. Equipment entrapment; 8. Vascular access considerations; 9. Contrast-induced acute kidney injury; 10. Radiation injury; 11 When to stop; and, 12. Proctorship. This statement complements the global CTO crossing algorithm; by advising how to prevent and deal with complications, this statement aims to facilitate clinical practice, research, and education relating to CTO PCI.
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Affiliation(s)
- Eugene B Wu
- Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong.
| | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology, II University Heart Center, Freiburg Bad Krozingen, Germany
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Du Q, Jiang T, Yuan Q, Bai Y, Lin D, Liu D. NMR-based metabolomic analysis of plasma from elderly patients with CVD before and after using contrast media. Heliyon 2024; 10:e30434. [PMID: 38737248 PMCID: PMC11088330 DOI: 10.1016/j.heliyon.2024.e30434] [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: 02/20/2024] [Revised: 03/24/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024] Open
Abstract
Contrast-induced acute kidney injury (CI-AKI) is a growingly common kidney problem caused by medical procedures involving contrast media (CM), especially in older patients with existing health issues. It is crucial to pinpoint potential biomarkers for the early detection of CI-AKI. Previously, we observed that iodixanol affects glucose, choline, and glutathione metabolism in endothelial cells under laboratory conditions. In this study, we used 1H NMR-based metabolomics to examine the metabolic changes in the blood plasma of elderly patients with cardiovascular disease (CVD) before and after receiving iodixanol. We identified altered metabolites in plasma 24 and 48 h after iodixanol injection compared to levels before injection. Notably, metabolites such as glucose, unsaturated fatty acids (UFA), low-density lipoprotein (LDL)/very low-density lipoprotein (VLDL), pyruvate, choline, and glycine showed potential as biomarkers at 24 h post-injection compared to levels before injection. Similarly, glucose, pyruvate, lactate, choline, and glycine in plasma could serve as potential biomarkers at 48 h post-injection. Iodixanol notably affected pathways related to glycolysis, fatty acid breakdown, and amino acid metabolism according to our metabolic pathway analysis. The altered levels of specific metabolites in plasma could be indicative of CM-induced kidney injury. Overall, this research aids in understanding the physiological mechanisms involved and in identifying early biomarkers and prevention strategies for CI-AKI.
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Affiliation(s)
- Qian Du
- Department of Cardiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, 510240, China
| | - Ting Jiang
- Key Laboratory for Chemical Biology of Fujian Province, MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen 361005, China
| | - Qiuju Yuan
- Department of Geriatrics, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, China
| | - Yuanyuan Bai
- Department of Geriatrics, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, China
| | - Donghai Lin
- Key Laboratory for Chemical Biology of Fujian Province, MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen 361005, China
| | - Donghui Liu
- Department of Geriatrics, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, China
- Provincial Clinical Medicine College of Fujian Medical University, Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
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4
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Khoche S. If a tree falls in the forest, is there an echo? Lessons learnt from the STS database analysis. J Cardiothorac Vasc Anesth 2024; 38:1112-1114. [PMID: 38514291 DOI: 10.1053/j.jvca.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Swapnil Khoche
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of California, San Diego, Thornton Hospital, 9444 Campus Point Drive #7651, La Jolla, California 92093.
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Rozenbaum Z, Chang MF, Wiley J, Gholam A, Irimpen A, Alsaad AA. Safety of ultra-low contrast coronary angiography in patients with acute kidney injury. Clin Cardiol 2024; 47:e24282. [PMID: 38801137 PMCID: PMC11129322 DOI: 10.1002/clc.24282] [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: 09/04/2023] [Revised: 12/14/2023] [Accepted: 05/07/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Ultra-low contrast administration during coronary angiography has been previously shown to be feasible and safe among patients with stable chronic kidney disease. In the present study, we investigate the safety of ultra-low contrast coronary angiography in patients with pre-existing acute kidney injury (AKI). METHODS The study was a retrospective single-center evaluation of hospitalized patients who had AKI and required coronary angiography. Ultra-low contrast use was defined as ≤18 mL of contrast media. RESULTS The cohort consisted of a case series of eight inpatients with AKI who required coronary angiography. The mean age was 57 (±16) years and half were females. All patients had chronic kidney disease with a mean baseline estimated glomerular filtration rate of 34 (±17) mL/min/1.73 m2. The mean creatinine before angiography was 3 (±1) mg/dL and volume of contrast administered was 14 (±4) mL. One patient had a 0.1 mg/dL increase in creatinine during admission, and no patients had further AKI up to 1-week postprocedure. CONCLUSIONS The current data suggest that ultra-low contrast coronary angiography can be safely performed in patients with pre-existing AKI The study should be viewed as hypothesis-generating due to its small sample size. A larger cohort is required to validate the results.
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Affiliation(s)
- Zach Rozenbaum
- Department of CardiologyTulane UniversityNew OrleansLouisianaUSA
| | | | - Jose Wiley
- Department of CardiologyTulane UniversityNew OrleansLouisianaUSA
| | - Ali Gholam
- Department of CardiologyTulane UniversityNew OrleansLouisianaUSA
| | - Anand Irimpen
- Department of CardiologyTulane UniversityNew OrleansLouisianaUSA
| | - Ali A. Alsaad
- Department of CardiologyTulane UniversityNew OrleansLouisianaUSA
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Yusuf J, Prakash G, Safal S, Mehta V, Mukhopadhyay S. Efficacy of nicorandil and ranolazine in prevention of contrast-induced nephropathy in patients with mild-to-moderate renal dysfunction: a randomized controlled trial. Coron Artery Dis 2024; 35:186-192. [PMID: 38411168 DOI: 10.1097/mca.0000000000001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Contrast-induced nephropathy (CIN) is a common complication after percutaneous coronary intervention (PCI). There is conflicting evidence regarding efficacy of nicorandil in CIN prevention. With respect to ranolazine, there is physiological possibility as well as data in animal study regarding its protective effect against CIN; there is, however, no human data till date. AIM AND OBJECTIVES To assess the efficacy of nicorandil and ranolazine in preventing CIN. The secondary endpoint was to measure difference in postprocedure acute kidney injury (AKI) incidence across groups. Also, patients were followed up till 6 months for major adverse events. MATERIAL AND METHODS This single-center randomized controlled study included 315 patients of coronary artery disease with mild-to-moderate renal dysfunction undergoing elective PCI. Eligible patients were assigned to either nicorandil (n = 105), ranolazine (n = 105) or control group (n = 105) in 1 : 1 : 1 ratio by block randomization. All enrolled patients were given intravenous sodium chloride at rate of 1.0 mL/kg/h (0.5 mL/kg/h for patients with left ventricular ejection fraction <45%) from 6 h before procedure till 12 h after procedure. Iso-osmolar contrast agent (iodixanol) was used for all patients. In addition to hydration, patients in nicorandil group received oral nicorandil (10 mg, 3 times/d) and those in ranolazine group received oral ranolazine (1000 mg, 2 times/d) 1 day before procedure and for 2 days after PCI. Patients in control group received only hydration. RESULTS Total number of CIN was 34 (10.7%), which included 19 (18.1%) in control, 8 (7.6%) in nicorandil and 7 (6.6%) in ranolazine group. There was significant association of CIN reduction across groups ( P = 0.012). On pairwise comparison also, there was significant benefit across control and ranolazine as well as control and nicorandil ( P < 0.025). There was numerically higher incidence of AKI in controls; the difference, however, did not reach statistical significance after applying Bonferroni correction ( P = 0.044). Over 6-month follow-up, adverse events were similar across groups. CONCLUSION While this study adds to existing literature that supports role for nicorandil in CIN prevention, the efficacy of ranolazine in protecting against CIN has been demonstrated in humans for the first time.
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Affiliation(s)
- Jamal Yusuf
- Department of Cardiology, Maulana Azad Medical College and GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Ricottini E, Coletti F, Nusca A, Cocco N, Corlianò A, Appetecchia A, Melfi R, Mangiacapra F, Gallo P, Rinaldi R, Grigioni F, Ussia GP. Coronary Chronic Total Occlusion Revascularization: When, Who and How? J Clin Med 2024; 13:1943. [PMID: 38610708 PMCID: PMC11012595 DOI: 10.3390/jcm13071943] [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: 02/27/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Coronary chronic total occlusions (CTO) are an increasingly frequent entity in clinical practice and represent a challenging percutaneous coronary intervention (PCI) scenario. Despite data from randomized trials that have not yet demonstrated a clear benefit of CTO recanalization, the widespread of CTO-PCI has substantially increased. The improvement in operators' techniques, equipment, and training programs has led to an improvement in the success rate and safety of these procedures, which will represent an important field of future development of PCI. The present review will summarize clinical outcomes and technical and safety issues of CTO revascularization with the aim to guide clinical daily cath-lab practice.
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Affiliation(s)
- Elisabetta Ricottini
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Federica Coletti
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Annunziata Nusca
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Nino Cocco
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Andrea Corlianò
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Alessandro Appetecchia
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Rosetta Melfi
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Fabio Mangiacapra
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Paolo Gallo
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Raffaele Rinaldi
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Francesco Grigioni
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Gian Paolo Ussia
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
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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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Losin I, Hagai KC, Pereg D. The Treatment of Coronary Artery Disease in Patients with Chronic Kidney Disease: Gaps, Challenges, and Solutions. KIDNEY DISEASES (BASEL, SWITZERLAND) 2024; 10:12-22. [PMID: 38322630 PMCID: PMC10843189 DOI: 10.1159/000533970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/23/2023] [Indexed: 02/08/2024]
Abstract
Background Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease (CAD), which remains the leading cause of death in CKD patients. Despite the high cardiovascular risk, ACS patients with renal dysfunction are less commonly treated with guideline-based medical therapy and are less frequently referred for coronary revascularization. Summary The management of CAD is more challenging in patients with CKD than in the general population due to concerns regarding side effects and renal toxicity, as well as uncertainty regarding clinical benefit of guideline-based medical therapy and interventions. Patients with advanced CKD and especially those receiving dialysis have not traditionally been represented in randomized trials evaluating either medical or revascularization therapies. Thus, only scant data from small prospective studies or retrospective analyses are available. Recently published studies suggest that there are significant opportunities to substantially improve both cardiovascular and renal outcomes of patients with CAD and CKD, including new medications and interventions. Thus, the objective of this review is to summarize the current evidence regarding the management of CAD in CKD patients, in particular with respect to improvement of both cardiovascular and renal outcomes. Key Messages Adequate medical therapy and coronary interventions using evidence-based strategies can improve both cardiac and renal outcomes in patients with CAD and CKD.
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Affiliation(s)
- Ilya Losin
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel
| | - Keren-Cohen Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Pereg
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Hassan Z, Kumari U, Wasim U, Kumari S, Daggula NR, Surani S, Ullah H. An Investigation of Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention: A Cross-Sectional Study From Pakistan. Cureus 2024; 16:e54726. [PMID: 38524020 PMCID: PMC10960921 DOI: 10.7759/cureus.54726] [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: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Background and objective Contrast-induced acute kidney injury (CIAKI) is a complication observed among individuals undergoing primary percutaneous coronary intervention (PCI) and is associated with high morbidity and mortality rates. It is characterized by an elevation in serum creatinine (SCr) levels >0.5 mg/dl or a 50% relative increase in SCr from the baseline value following exposure to contrast within a 48- to 72-hour timeframe, in the absence of any alternative causes for acute kidney injury (AKI). This study aimed to assess the incidence of CIAKI in patients following PCI. Methods This prospective study was conducted from July to December 2022, after obtaining ethical approval from the institutional ethics committee (reference no: 147/LRH/MTI). A total of 159 consecutive patients who met the selection criteria were enrolled. A detailed patient and family history was obtained, and a thorough physical examination was conducted. Baseline tests, including SCr, were performed, with SCr repeated 72 hours post-PCI. All investigations were performed in the affiliated hospital's main laboratory and conducted by the same biochemist. Results The study included 159 patients presenting with myocardial infarction, angina pectoris, or ischemic features on EKG, exercise tolerance test (ETT), or echocardiogram and underwent PCI. The patients had a mean age of 51 ± 9 years, baseline SCr of 0.77 ± 0.41 mg/dl, SCr 72 hours post-procedure of 0.83 ± 0.41 mg/dl, and an average contrast volume of 128.6 ± 63 ml; 87 (55%) patients were male, and 72 (45%) were female. CIAKI was observed in 15 (9.4%) patients. Hypertension and diabetes mellitus were the most prevalent comorbidities. Male gender, diabetes mellitus, and hypertension had a clinically significant association with the development of CIAKI (p<0.05). ST-elevation myocardial infarction (STEMI) was the predominant clinical presentation in 81 (50.9%) cases. Conclusions This study examines the frequency, risk factors, and associations of CIAKI following PCI at a tertiary care hospital in a low-middle-income country. We believe our findings provide future directions for identifying and minimizing the risk of CIAKI in this patient population.
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Affiliation(s)
- Zair Hassan
- Cardiology, Lady Reading Hospital, Peshawar, PAK
| | - Usha Kumari
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Sanjana Kumari
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Salim Surani
- Anesthesiology, Mayo Clinic, Rochester, USA
- Medicine, Texas A&M University, College Station, USA
- Medicine, University of North Texas, Dallas, USA
- Internal Medicine, Pulmonary Associates, Corpus Christi, USA
- Clinical Medicine, University of Houston, Houston, USA
| | - Hazir Ullah
- Nephrology, Jinnah Teaching Hospital, Peshawar, PAK
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12
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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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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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14
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Pranata R, Wahyudi DP. Prevention of Contrast-induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention. Curr Cardiol Rev 2023; 20:CCR-EPUB-135553. [PMID: 37877506 PMCID: PMC11071674 DOI: 10.2174/011573403x260319231016075216] [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: 05/02/2023] [Revised: 08/21/2023] [Accepted: 08/31/2023] [Indexed: 10/26/2023] Open
Abstract
Contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury has varying definitions, but in general, increased serum creatinine level by ≥ 0.3 mg/dL (26.5 µmol/L) or 1.5x of baseline value or urine output <0.5 mL/kg/h within 1-7 days after contrast media (CM) administration can be considered as CIN. CIN is one of the most common complications and is associated with increased mortality in patients undergoing percutaneous coronary intervention (PCI). Thus, risk stratification for CIN should be made and preventive strategies should be employed in which the intensity of the approach must be tailored to patient's risk profile. In all patients, adequate hydration is required, nephrotoxic medications should be discontinued, and pre-procedural high-intensity statin is recommended. In patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, IV hydration should be started 12 hours pre-procedure up until 12-24 hours after the procedure. Remote ischemic preconditioning may be performed pre-procedurally. Radial first approach for vascular access is recommended. During the procedure, low or iso-osmolar CM should be used and its volume should be limited to eGFR x 3.7. In patients at high risk for CIN, additional contrast-sparing strategies may be applied, such as using a contrast reduction system, 5 Fr catheter with no sideholes, CM dilution, limiting test injection, confirming placement using guidewire, use of stent enhancing imaging technology, using metallic/software roadmap to guide PCI, use of IVUS or dextran-based OCT, and coronary aspiration. A more advanced hydration technique based on central venous pressure, left ventricular end-diastolic pressure, or using furosemide-matched hydration, might be considered.
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Affiliation(s)
- Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Dendi Puji Wahyudi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
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15
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Gurm HS. A Practical Approach to Preventing Contrast-Associated Renal Complications in the Catheterization Laboratory. Interv Cardiol Clin 2023; 12:525-529. [PMID: 37673496 DOI: 10.1016/j.iccl.2023.06.003] [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: 09/08/2023]
Abstract
Contrast media use is ubiquitous in the catheterization laboratory. Contrast-associated acute kidney injury (CA-AKI) is a key concern among patients undergoing coronary angiography and percutaneous coronary interventions. The risk of CA-AKI can be minimized by careful attention to hydration status and renal function-based contrast dosing in all patients. In patients with Stage IV chronic kidney disease, ultra low contrast procedure (contrast dose ≤ GFR) may be especially beneficial.
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Affiliation(s)
- Hitinder S Gurm
- Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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16
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Hirano S, Yabe T, Oka Y, Kojima Y, Aikawa H, Noike R, Amano H, Ikeda T. Clinical Outcomes of Patients with Chronic Kidney Disease Undergoing Percutaneous Coronary Interventions with a Novel Dynamic Coronary Roadmap System. Int Heart J 2023; 64:823-831. [PMID: 37704405 DOI: 10.1536/ihj.23-213] [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] [Indexed: 09/15/2023]
Abstract
Dynamic coronary roadmap (DCR) is a novel technology that creates a real-time overlay of the coronary arteries in percutaneous coronary intervention (PCI) and has the potential to reduce the contrast volume. However, the efficacy of DCR in terms of clinical outcomes in patients with chronic kidney disease (CKD) remains to be fully elucidated.This single center retrospective study enrolled 275 patients with CKD who underwent PCI, and divided them into a DCR group (n = 124) and Non-DCR group (n = 151). Propensity score matching was performed to minimize the differences in baseline characteristics in 113 patient pairs. The primary endpoint was a composite outcome of all-cause death, hospitalization for heart failure, nonfatal myocardial infarction, or the introductory rate of dialysis within 2 years. The secondary endpoints were contrast medium volume, the incidence of contrast-induced acute kidney injury (CI-AKI), and the introductory rate of dialysis within 2 years.Although there was no significant difference in the success rate (DCR group: 99.1% versus Non-DCR group: 98.2%; P = 0.561), contrast volume (92.20 mL versus 115.97 mL; P = 0.002) was significantly lower in the DCR group. CI-AKI incidence was 0.9% versus 6.2% in the DCR and Non-DCR groups, respectively (P = 0.031). The composite outcome defined as primary endpoint occurred in 10 patients in the DCR group and 20 patients in the Non-DCR group (8.8% versus 17.7%; P = 0.049).From the perspective of acute and long-term clinical outcomes, DCR use may be effective for patients with CKD.
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Affiliation(s)
- Shojiro Hirano
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Graduate School of Medicine
| | - Takayuki Yabe
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Graduate School of Medicine
| | - Yosuke Oka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University
| | - Yoshimasa Kojima
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University
| | - Hiroto Aikawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University
| | - Ryota Noike
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University
| | - Hideo Amano
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Graduate School of Medicine
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Graduate School of Medicine
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17
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Fan J, Liu J, Wang G, Liu R. Dynamic Changes in the Renal Function of Acute Myocardial Infarction Patients with Reduced eGFR After Emergency Percutaneous Coronary Intervention. Int Heart J 2023; 64:798-806. [PMID: 37704408 DOI: 10.1536/ihj.23-102] [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] [Indexed: 09/15/2023]
Abstract
Renal dysfunction greatly influences decision-making for emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). This observational study investigated renal function changes and risk factors for renal injury in patients with AMI with reduced estimated glomerular filtration rate (eGFR) who underwent emergency PCI. The study included 85 patients with AMI with decreased eGFR who underwent emergency PCI, categorized into stage 2, 3, and 4 chronic kidney disease groups. Baseline data, laboratory indicators, coronary characteristics, and serum creatinine concentration were monitored at multiple time points. Renal injury was defined using two criteria: an increase in serum creatinine level by 0.3 mg/dL or a 50% increase from baseline. During the 1-year follow-up, renal injury incidence varied from 1.18% to 15.29%. The pattern showed an increasing trend in the 1st week after PCI, peaking at 1 week, followed by a decrease at 3 months, and another increase at one year. Low basal eGFR, high contrast agent dosage, and diabetes were associated with renal injury according to logistic regression analysis. The eGFR cutoff value of 35.475 mL/minute·1.73 m2 had a sensitivity of 83.05% and specificity of 57.69% for predicting renal injury based on receiver operating characteristic curve analysis. In summary, patients with AMI with basal eGFR lower than 35.475 mL/minute·1.73 m2 have a higher risk of renal injury after PCI. These findings emphasize the importance of assessing renal function and considering associated risk factors when deciding on emergency PCI for AMI with reduced eGFR.
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Affiliation(s)
- Jihong Fan
- Department of Cardiology, Beijing Friendship Hospital Affiliated with Capital Medical University
| | - Jianghong Liu
- Department of Cardiology, Beijing Friendship Hospital Affiliated with Capital Medical University
| | - Gang Wang
- Department of Cardiology, Beijing Friendship Hospital Affiliated with Capital Medical University
| | - Ruifeng Liu
- Department of Cardiology, Beijing Friendship Hospital Affiliated with Capital Medical University
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18
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Mehta R, Sorbo D, Ronco F, Ronco C. Key Considerations regarding the Renal Risks of Iodinated Contrast Media: The Nephrologist's Role. Cardiorenal Med 2023; 13:324-331. [PMID: 37757781 PMCID: PMC10664334 DOI: 10.1159/000533282] [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: 03/27/2023] [Accepted: 06/23/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The administration of iodinated contrast medium during diagnostic and therapeutic procedures has always been associated with the fear of causing acute kidney injury (AKI) or an exacerbation of chronic kidney disease. This has led, on the one hand, to the deterrence, when possible, of the use of contrast medium (preferring other imaging methods with the risk of loss of diagnostic power), and on the other hand, to the trialling of multiple prophylaxis protocols in an attempt to reduce the risk of kidney injury. SUMMARY A literature review on contrast-induced (CI)-AKI risk mitigation strategies was performed, focussing on the recognition of individual risk factors and on the most recent evidence regarding prophylaxis. KEY MESSAGES Nephrologists can contribute significantly in the CI-AKI context, from the early stages of the decision-making process to stratifying patients by risk, individualising prophylaxis measures based on the risk profile, and ensuring appropriate evaluation of kidney function and damage post-procedure to improve care.
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Affiliation(s)
- Ravindra Mehta
- Division of Nephrology-Hypertension University of California – San Diego, San Diego, CA, USA
| | - David Sorbo
- Nephrology, Dialysis and Transplantation Unit, St. Bortolo Hospital, ULSS8 Berica, Vicenza, Italy
| | - Federico Ronco
- Interventional Cardiology – Department of Cardiac Thoracic and Vascular Sciences Ospedale dell’Angelo – Mestre (Venice), Venice, Italy
| | - Claudio Ronco
- Nephrology, Dialysis and Transplantation Unit and International Renal Research Institute, St Bortolo Hospital, ULSS8 Berica, Vicenza, Italy
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19
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Almallouhi E, Sattur M, Lajthia O, Kicielinski KP, Holmstedt C, Lena JR, Al Kasab S, Spiotta AM. Contrast conservation measures during the global iohexol contrast shortage crisis did not affect stroke thrombectomy outcomes. J Neurointerv Surg 2023; 15:e76-e78. [PMID: 35882555 DOI: 10.1136/jnis-2022-019210] [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: 05/27/2022] [Accepted: 06/29/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The current global shortage in iohexol contrast material (Omnipaque) used in performing CT-based triage images and mechanical thrombectomy (MT) represents a challenge to the healthcare system. A study was undertaken to assess the safety and feasibility of implementing protocol-based changes in pre-MT and MT workflow at a comprehensive stroke center. METHODS A retrospective cohort study was undertaken of all patients with stroke who underwent MT during a 3-week period before implementing the contrast shortage protocol and for 3 weeks while implementing the protocol. The contrast shortage protocol included not performing perfusion images for MT selection and using diluted iohexol (50% contrast mixed with 50% heparinized saline) during the MT procedure. Procedural variables were compared between the two groups. RESULTS A total of 27 patients underwent MT during the study period, 12 pre-contrast shortage and 15 post-contrast shortage. The average contrast volume used during the MT procedure was reduced from 83 mL to 68 mL after implementing the contrast shortage protocol (p=0.04). No difference was noted in the rate of successful reperfusion (11/15 vs 10/12), average time to recanalization (21 vs 23 min), average radiation dose (1143 vs 1117mGy) and time under fluoroscopy (20.7 vs 20.5 min) in the pre- and post-contrast shortage groups. A favorable discharge outcome was observed in 3/12 patients and 4/15 patients in the pre- and post-shortage periods, respectively (p=0.92). CONCLUSIONS Modifying stroke workflow to adapt to the current global shortage in iohexol is feasible. Using diluted iohexol (50% contrast mixed with 50% heparinized saline) did not affect MT outcomes.
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Affiliation(s)
- Eyad Almallouhi
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Mithun Sattur
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Orgest Lajthia
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kimberly P Kicielinski
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christine Holmstedt
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Jonathan R Lena
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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20
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Feitosa MPM, Lima EG, Abizaid AAC, Mehran R, Lopes NHM, de Assis Fischer Ramos T, Hideo-Kajita A, Filho RK, Junior CVS. The safety of SGLT-2 inhibitors in diabetic patients submitted to elective percutaneous coronary intervention regarding kidney function: SAFE-PCI pilot study. Diabetol Metab Syndr 2023; 15:138. [PMID: 37365618 DOI: 10.1186/s13098-023-01107-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is one of the most performed well-succeeded therapeutic procedures worldwide, reducing symptoms and improving quality of life. Neutrophil Gelatinase-associated Lipocalin (NGAL) is a biomarker of acute kidney injury (AKI) produced early after an ischemic renal insult. Osmotic diuresis and the vasoconstriction of the afferent arteriole promoted by Sodium-glucose Cotransporter-2 Inhibitors (SGLT2i) generate a concern regarding the possibility of dehydration and consequent AKI. There is no consensus on the maintenance or discontinuation of SGTL2i in patients who will undergo PCI. This study aimed to evaluate the safety of empagliflozin in diabetic patients submitted to elective PCI regarding kidney function. METHODS SAFE-PCI trial is a prospective, open-label, randomized (1:1), single-center pilot study and a follow-up of 30 days. The SGLT2i empagliflozin 25 mg daily was initiated at least 15 days before PCI in the intervention group and maintained until the end of the follow-up period. Serum NGAL was collected 6 h after PCI and creatinine before PCI, 24 h, and 48 h after the procedure. As per protocol, both groups received optimal medical treatment and standard protocol of nephroprotection. RESULTS A total of 42 patients were randomized (22 patients in the iSGLT-2 group and 20 patients in the control group). There was no difference between-group baseline data. The primary outcome (NGAL and creatinine values post PCI) did not differ in both groups: the mean NGAL value was 199 ng/dL in the empagliflozin group and 150 ng/dL in the control group (p = 0.249). Although there was an initial increase in creatinine in the SGLT-2i group compared to the control group between baseline creatinine and pre-PCI and 24 h post-PCI creatinine, no difference was detected in creatinine 48 h post-PCI (p = 0.065). The incidence of CI-AKI, determined by KDIGO criteria, in the iSGLT2-group was 13.6% and 10.0% in the control group without statistical difference. CONCLUSION The present study showed that the use of empagliflozin is safe regarding kidney function during elective PCI in patients with T2D when compared with no use of SGLT2i. Trial registration Our clinical study is registered on ClinicalTrials.gov with the following number: NCT05037695.
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Affiliation(s)
- Mateus Paiva Marques Feitosa
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
- Av. Dr. Eneas de Carvalho Aguiar 44, Departamento de Aterosclerose, 2nd Floor, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
| | - Eduardo Gomes Lima
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Antônio Cunha Abizaid
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Neuza Helena Moreira Lopes
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Thiago de Assis Fischer Ramos
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Hideo-Kajita
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Vicente Serrano Junior
- Instituto Do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Liu Y, Tan N, Huo Y, Chen SQ, Liu J, Wang Y, Li L, Tao JH, Su X, Zhang L, Li QX, Zhang JY, Guo YS, Du ZM, Zhou YP, Fang ZF, Xu GM, Liang Y, Tao L, Chen H, Ji Z, Han B, Chen PY, Ge JB, Han YL, Chen JY. Simplified Rapid Hydration Prevents Contrast-Associated Acute Kidney Injury Among CKD Patients Undergoing Coronary Angiography. JACC Cardiovasc Interv 2023; 16:1503-1513. [PMID: 37380233 DOI: 10.1016/j.jcin.2023.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) undergoing coronary angiography (CAG) are at high risk of contrast-associated acute kidney injury (CA-AKI) and mortality. Therefore, there is a clinical need to explore safe, convenient, and effective strategies for preventing CA-AKI. OBJECTIVES This study sought to assess whether simplified rapid hydration is noninferior to standard hydration for CA-AKI prevention in patients with CKD. METHODS This multicenter, open-label, randomized controlled study was conducted across 21 teaching hospitals and included 1,002 patients with CKD. Patients were randomized to either simplified hydration (SH) (SH group, with normal saline from 1 hour before to 4 hours after CAG at a rate of 3 mL/kg/h) or standard hydration (control group, with normal saline 12 hours before and 12 hours after CAG at a rate of 1 mL/kg/h). The primary endpoint of CA-AKI was a ≥25% or 0.5-mg/dL rise in serum creatinine from baseline within 48 to 72 hours. RESULTS CA-AKI occurred in 29 of 466 (6.2%) patients in the SH group and in 38 of 455 (8.4%) patients in the control group (relative risk: 0.8; 95% CI: 0.5-1.2; P = 0.216). In addition, the risk of acute heart failure and 1-year major adverse cardiovascular events did not differ significantly between the groups. However, the median hydration duration was significantly shorter in the SH group than in the control group (6 vs 25 hours; P < 0.001). CONCLUSIONS In CKD patients undergoing CAG, SH is noninferior to standard hydration in preventing CA-AKI with a shorter hydration duration.
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Affiliation(s)
- Yong Liu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of 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 Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Shi-Qun Chen
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yan Wang
- Xiamen Key Laboratory of Cardiovascular Disease, Xiamen Cardiovascular Hospital Xiamen University, Xiamen, China
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Jian-Hong Tao
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Li Zhang
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Qing-Xian Li
- Department of Cardiology, Affiliated Hospital, Jining Medical College, Shandong, China
| | - Jin-Ying Zhang
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan-Song Guo
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Zhi-Min Du
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Department of Heart Brain and Vessel Diseases, Dongguan Tungwah Hospital, Dongguan, China
| | - Yin-Pin Zhou
- Department of Cardiology, ChongQing FuLing Central Hospital, Chong Qing, China
| | - Zhen-Fei Fang
- Department of Cardiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Guang-Ma Xu
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Province, China
| | - Yan Liang
- Department of Cardiology, Maoming People's Hospital, Maoming, China
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Air Force Military Medical University, Shaanxi, China
| | - Hui Chen
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Ji
- Department of Cardiology, Tangshan Gongren Hospital, Hebei, China
| | - Bing Han
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
| | - Ping-Yan Chen
- Department of Biostatistics, Southern Medical University, Guangzhou, China
| | - Jun-Bo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Ya-Ling Han
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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22
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Dąbrowski EJ, Święczkowski M, Dudzik JM, Grunwald O, Januszko T, Muszyński P, Pogorzelski P, Tokarewicz J, Południewski M, Kożuch M, Dobrzycki S. Percutaneous Coronary Intervention for Chronic Total Occlusion-Contemporary Approach and Future Directions. J Clin Med 2023; 12:jcm12113762. [PMID: 37297958 DOI: 10.3390/jcm12113762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
In the aging society, the issue of coronary chronic total occlusion (CTO) has become a challenge for invasive cardiologists. Despite the lack of clear indications in European and American guidelines, the rates of percutaneous coronary interventions (PCI) for CTO increased over the last years. Well-conducted randomized clinical trials (RCT) and large observational studies brought significant and substantial progress in many CTO blind spots. However, the results regarding the rationale behind revascularization and the long-term benefit of CTO are inconclusive. Knowing the uncertainties regarding PCI CTO, our work sought to sum up and provide a comprehensive review of the latest evidence on percutaneous recanalization of coronary artery chronic total occlusion.
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Affiliation(s)
- Emil Julian Dąbrowski
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Michał Święczkowski
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Joanna Maria Dudzik
- Second Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Oliwia Grunwald
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Tomasz Januszko
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Paweł Muszyński
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Piotr Pogorzelski
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Justyna Tokarewicz
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Maciej Południewski
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Marcin Kożuch
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
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23
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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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24
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Dianatkhah M, Poursaeid S, Shirvani E, Badri S. Investigating the Prevalence of Contrast-associated Nephropathy and the Related Risk Factors in Patients Undergoing Elective Angioplasty. J Res Pharm Pract 2023; 12:64-67. [PMID: 38463185 PMCID: PMC10923199 DOI: 10.4103/jrpp.jrpp_1_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2024] Open
Abstract
Objective Contrast-associated nephropathy (CAN) is a sudden decrease in kidney function following contrast media administration. Considering the importance of CAN in the patient's outcome and the high prevalence of this complication in cardiac catheterizing centers, this study was designed to investigate the prevalence and the related risk factors of CAN in patients undergoing angioplasty in Chamran Heart Hospital, Isfahan, Iran, from January 2022 to June 2022. Methods The inclusion criteria were adult patients above 18 admitted for elective percutaneous coronary intervention (PCI). Patient demographic information, underlying diseases and medications, dehydration state, type and amount of contrast media, and serum levels of blood urea nitrogen (BUN) and serum creatinine (SrCr) at 24 and 72 h after contrast injection were all recorded. Findings Out of 340, 128 patients developed CAN after PCI, giving an incidence of 37.64%. Adjusted analysis showed a significant relation between age over 65, the amount of contrast media administered, and the use of furosemide with the incidence of CAN. However, adjusted logistic regression analysis failed to show any significant relationship between the risk of CAN and the hydration status of the patients at 24 and 48 h after receiving contrast media as diagnosed by BUN/SrCr >20. Conclusion The prevalence of CAN in this study was higher than in other studies since this high-risk population was under risk factors such as arterial injection of contrast material and a higher amount of contrast material administration. In addition, advanced age, volume of contrast material, and previous or concurrent furosemide administration were associated with an increased risk of CAN.
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Affiliation(s)
- Mehrnoush Dianatkhah
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samira Poursaeid
- Pharmacy Students’ Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ehsan Shirvani
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirinsadat Badri
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
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25
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Hennessey, Shabbir A, Travieso A, Gonzalo N, Escaned J. Procedural and Technological Innovations Facilitating Ultra-low Contrast Percutaneous Coronary Interventions. Interv Cardiol 2023. [DOI: 10.15420/icr.2022.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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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26
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Hooda F, Kassam N, Somji S, Makakala M, Noorani M, Bakshi F, Mvungi R. Prevalence & Factors Associated With Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention at a Tertiary Healthcare Facility in Tanzania. Cureus 2023; 15:e36219. [PMID: 37065411 PMCID: PMC10103833 DOI: 10.7759/cureus.36219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is the leading cause of mortality and morbidity globally. Percutaneous coronary intervention (PCI) is a minimally-invasive lifesaving intervention for these patients; however, acute kidney injury (AKI) is a serious complication of the procedure commonly occurring due to radiocontrast-induced nephropathy. METHODS A retrospective cross-sectional analytical study was carried out at the Aga Khan Hospital, Dar es Salaam (AKH,D), Tanzania. A total of 227 adults who underwent a percutaneous coronary intervention from August 2014 to December 2020 were enrolled. The AKI was defined based on an increase in absolute and rise in percentage creatinine using the Acute Kidney Injury Network (AKIN), and contrast-induced acute kidney injury (CI-AKI) by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Bivariable and multivariable logistic regression was utilized to analyze factors associated with AKI and the outcomes of these patients. RESULTS Twenty-two of the 227 (9.7%) participants sustained AKI. The majority of the study population was male and of Asian ethnicity. No statistically significant factors were associated with AKI. The in-hospital mortality rate was 9% for the AKI versus 2% for non-AKI groups. The AKI group had a longer hospital stay and required ICU care and organ support including hemodialysis. CONCLUSIONS Nearly 1-in-10 patients undergoing PCI are likely to develop AKI. The in-hospital mortality rate is x4.5 times higher for patients with AKI post-PCI compared to those without AKI. Further larger studies are recommended to determine factors associated with AKI in this population.
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27
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Rudnick MR, Chaknos CM. Can Quality Improvement Reduce the Risk of Contrast-Associated Acute Kidney Injury? Clin J Am Soc Nephrol 2023; 18:300-302. [PMID: 36888886 PMCID: PMC10103337 DOI: 10.2215/cjn.0000000000000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
- Michael R Rudnick
- Nephrology Division, University of Pennsylvania, Philadelphia, Pennsylvania
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28
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Luo M, Zhu Z, Zhang L, Zhang S, You Z, Chen H, Rao J, Lin K, Guo Y. Predictive Value of N-Terminal Pro B-Type Natriuretic Peptide for Contrast-Induced Nephropathy Non-Recovery and Poor Outcomes Among Patients Undergoing Percutaneous Coronary Intervention. Circ J 2023; 87:258-265. [PMID: 36288935 DOI: 10.1253/circj.cj-22-0399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a frequent complication in patients undergoing percutaneous coronary intervention (PCI). The degree of recovery of renal function from CIN may affect long-term prognosis. N-terminal pro B-type natriuretic peptide (NT-proBNP) is a simple but useful biomarker for predicting CIN. However, the predictive value of preprocedural NT-proBNP for CIN non-recovery and long-term outcomes in patients undergoing PCI remains unclear.Methods and Results: This study prospectively enrolled 550 patients with CIN after PCI between January 2012 and December 2018. CIN non-recovery was defined as persistent serum creatinine >25% or 0.5 mg/dL over baseline from 1 week to 12 months after PCI in patients who developed CIN. CIN non-recovery was observed in 40 (7.3%) patients. Receiver operating characteristic analysis indicated that the best NT-proBNP cut-off value for detecting CIN non-recovery was 876.1 pg/mL (area under the curve 0.768; 95% confidence interval [CI] 0.731-0.803). After adjusting for potential confounders, multivariable analysis indicated that NT-proBNP >876.1 pg/mL was an independent predictor of CIN non-recovery (odds ratio 1.94; 95% CI 1.03-3.75; P=0.0042). Kaplan-Meier curves showed higher rates of long-term mortality among patients with CIN non-recovery than those with CIN recovery (Chi-squared=14.183, log-rank P=0.0002). CONCLUSIONS Preprocedural NT-proBNP was associated with CIN non-recovery among patients undergoing PCI. The optimal cut-off value for NT-proBNP to predict CIN non-recovery was 876.1 pg/mL.
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Affiliation(s)
- Manqing Luo
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
| | - Zheng Zhu
- Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital
| | - Liwei Zhang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
| | - Sicheng Zhang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
| | - Zhebin You
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance.,Fujian Key Laboratory of Geriatrics, Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fujian Medical University
| | - Hanchuan Chen
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
| | - Jingyi Rao
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
| | - Kaiyang Lin
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
| | - Yansong Guo
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases.,Fujian Heart Failure Center Alliance
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29
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Kuznetsov VA, Mironova OI, Gritsanchuk AM, Fomin VV. Contrast-associated acute kidney injury after percutaneous coronary interventions in patients with acute coronary syndrome: a real-world study. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.10.201925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim. To study the incidence of contrast-associated acute kidney injury (CA-AKI) in patients with various forms of the acute coronary syndrome (ACS).
Materials and methods. An observational, open, single-center, prospective study included 83 patients with ACS with indications for percutaneous coronary intervention. Of these, 40 were included in the ST-segment elevation ACS group, and 43 patients were included in the non-ST-segment elevation ACS group. The study is registered at ClinicalTrials.gov as NCT04163484. Before the intervention, all patients had a general examination, ECG, complete blood count, blood chemistry, and blood coagulation tests. Later, 24 and 48 hours after the intervention, the serum creatinine (SC) trend was assessed. The primary endpoint was the development of in-hospital CA-AKI according to KDIGO criteria within 72 h or before hospital discharge.
Results. An increase in SC level by 25% from the baseline was observed in 6 patients in each subgroup of ACS. A marked increase in SC by 50% and a decrease in glomerular filtration rate were reported only in 2 patients (one in each subgroup of ACS).
Conclusion. The study showed that the incidence of CA-AKI in patients with ACS with ST-segment elevation was 2.3%, and in the group of patients with ACS without ST-segment elevation 2.5%.
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30
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Prasad A, Palevsky PM, Bansal S, Chertow GM, Kaufman J, Kashani K, Kim ES, Sridharan L, Amin AP, Bangalore S, Briguori C, Charytan DM, Eng M, Jneid H, Brown JR, Mehran R, Sarnak MJ, Solomon R, Thakar CV, Fowler K, Weisbord S. Management of Patients With Kidney Disease in Need of Cardiovascular Catheterization: A Scientific Workshop Cosponsored by the National Kidney Foundation and the Society for Cardiovascular Angiography and Interventions. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100445. [PMID: 39132354 PMCID: PMC11307971 DOI: 10.1016/j.jscai.2022.100445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 08/13/2024]
Abstract
Patients with chronic kidney disease (CKD) are at an increased risk of developing cardiovascular disease (CVD), whereas those with established CVD are at risk of incident or progressive CKD. Compared with individuals with normal or near normal kidney function, there are fewer data to guide the management of patients with CVD and CKD. As a joint effort between the National Kidney Foundation and the Society for Cardiovascular Angiography and Interventions, a workshop and subsequent review of the published literature was held. The present document summarizes the best practice recommendations of the working group and highlights areas for further investigation.
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Affiliation(s)
- Anand Prasad
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
| | - Paul M. Palevsky
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine and Kidney Medicine Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Shweta Bansal
- Department of Medicine, Division of Nephrology, UT Health San Antonio, San Antonio, Texas
| | - Glenn M. Chertow
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - James Kaufman
- Department of Medicine, Division of Nephrology, NYU Grossman School of Medicine, New York, New York
- VA New York Harbor Healthcare System, New York, New York
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Esther S.H. Kim
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lakshmi Sridharan
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia
| | - Amit P. Amin
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Sripal Bangalore
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, New York
| | - Carlo Briguori
- Laboratory of Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - David M. Charytan
- Department of Medicine, Division of Nephrology, NYU Grossman School of Medicine, New York, New York
| | - Marvin Eng
- Banner University Medical Center, Phoenix, Arizona
| | - Hani Jneid
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jeremiah R. Brown
- Departments of Epidemiology, Biomedical Data Science, and Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute at Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark J. Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Richard Solomon
- Division of Nephrology and Hypertension, University of Vermont School of Medicine, Burlington, Vermont
| | | | - Kevin Fowler
- Principal, Voice of the Patient, Inc, St Louis, Missouri
| | - Steven Weisbord
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine and Kidney Medicine Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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31
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Pershad A. Saving the Kidneys Takes a Village. JACC Cardiovasc Interv 2022; 15:2230-2231. [DOI: 10.1016/j.jcin.2022.09.018] [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: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022]
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32
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Isaac T, Gilani S, Kleiman NS. When Prevention is Truly Better than Cure: Contrast-Associated Acute Kidney Injury in Percutaneous Coronary Intervention. Methodist Debakey Cardiovasc J 2022; 18:73-85. [PMID: 36132584 PMCID: PMC9461685 DOI: 10.14797/mdcvj.1136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/01/2022] [Indexed: 11/08/2022] Open
Abstract
Contrast-associated acute kidney injury (CA-AKI) is a fairly frequent complication of cardiovascular angiography and percutaneous coronary intervention (PCI). The risk is significantly higher in patients with advanced chronic kidney disease (CKD). Prevention is the only option for avoiding the significant morbidity and mortality associated with CA-AKI. This review provides a concise and clinically directed appraisal of the latest pre-procedural and peri-procedural strategies to minimize the risk of CA-AKI in all patients undergoing PCI. By broadly implementing these evidence-based care bundles, we can dramatically improve outcomes in this vulnerable patient population.
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Affiliation(s)
- Tea Isaac
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Salima Gilani
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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33
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Kwon W, Choi KH, Jeong DS, Lee SY, Lee JM, Park TK, Yang JH, Hahn JY, Choi SH, Chung SR, Cho YH, Sung K, Kim WS, Gwon HC, Lee YT, Song YB. Comparison of long-term cardiovascular and renal outcomes between percutaneous coronary intervention and coronary artery bypass grafting in multi-vessel disease with chronic kidney disease. Front Cardiovasc Med 2022; 9:951113. [PMID: 36172577 PMCID: PMC9510652 DOI: 10.3389/fcvm.2022.951113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/19/2022] [Indexed: 12/01/2022] Open
Abstract
Objective This study aims to analyze cardiac and renal outcomes of chronic kidney disease (CKD) patients with multi-vessel disease who have undergone coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Materials and methods Chronic kidney disease patients with multi-vessel disease who underwent CABG or PCI were retrospectively selected from our database and divided into the PCI group [further stratified into PCI with complete revascularization (PCI-CR) and PCI with incomplete revascularization (PCI-IR) groups] and the CABG group. The primary endpoint was the composite of all-cause death, myocardial infarction (MI), or stroke at 5 years. The key secondary endpoint was the 5-year rate of the renal composite outcome, defined as >40% glomerular filtration rate decrease, initiation of dialysis, and/or kidney transplant. Outcomes were compared using Cox proportional hazards regression analysis, and the results were further adjusted by multivariable analyses and inverse probability weighting. Results Among the study population (n = 798), 443 (55.5%) patients received CABG and 355 (44.5%) patients received PCI. Compared with the CABG group, the PCI group had similar risk of the primary endpoint (CABG vs. PCI, 19.3% vs. 24.0%, HR: 1.28, 95% CI: 0.95–1.73, p = 0.11) and a lower risk of the renal composite outcome (36.6% vs. 31.2%, HR: 0.74, 95% CI 0.58–0.94, p = 0.03). In addition, PCI-IR was associated with a significantly higher risk of the primary endpoint than CABG (HR: 1.54, 95% CI: 1.11–2.13, p = 0.009) or PCI-CR (HR: 1.78, 95% CI: 1.09–2.89, p = 0.02). However, PCI-CR had a comparable 5-year death, MI, or stroke rate to CABG (HR: 0.86, 95% CI 0.54–1.38, p = 0.54). Conclusion Coronary artery bypass grafting showed an incidence of death, MI, or stroke similar to PCI but was associated with a higher risk of renal injury. PCI-CR had a prognosis comparable with that of CABG, while PCI-IR had worse prognosis. If PCI is chosen for revascularization in patients with CKD, achieving CR should be attempted to ensure favorable outcomes. Clinical trial registration [clinicaltrials.gov], identifier [NCT 03870815].
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Affiliation(s)
- Woochan Kwon
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Sang Yoon Lee
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Su Ryeun Chung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea
- *Correspondence: Young Bin Song,
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Shrivastava A, Nath RK, Mahapatra HS, Pandit BN, Raj A, Sharma AK, Kumar T, Kuber D, Aggarwal P. Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI). Indian Heart J 2022; 74:363-368. [PMID: 36007555 PMCID: PMC9647695 DOI: 10.1016/j.ihj.2022.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/20/2022] [Accepted: 08/17/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives This prospective, randomized study assessed short-term outcomes and safety of ultra-low contrast percutaneous coronary intervention(ULC-PCI) vs conventional PCI in high risk for contrast induced acute kidney injury(CI-AKI) patients presenting with acute coronary syndrome(ACS). Background Patients at an increased risk of developing CI-AKI can be identified prior to PCI based on their pre-procedural risk scores. ULC-PCI is a novel contrast conservation strategy in such high risk patients for prevention of CI-AKI. Methods 82 patients undergoing PCI for ACS were enrolled having estimated glomerular filtration rate(eGFR) < 60 ml/min/1.73 m2 and moderate to very high pre-procedural risk of developing CI-AKI as calculated by Maioli risk calculator. They were randomized into two groups of 41 patients each of ULC-PCI (contrast volume ≤ patient's eGFR) and conventional PCI (contrast volume ≤ 3xpatient's eGFR). Primary end point was development of CI-AKI. Results Baseline clinical and angiographic characteristics were similar between groups. Primary outcome of CI-AKI occurred more in patients of the conventional PCI group [7 (17.1%)] than in the ULC PCI group [(0 patients), p = 0.012]. Contrast volume (41.02 (±9.8) ml vs 112.54 (±25.18) ml; P < 0.0001) was markedly lower in the ULC-PCI group. No significant difference in secondary safety outcomes between two study arms at 30 days. IVUS was used in 17% patients in ULC PCI. Conclusion ULC-PCI in patients with increased risk of developing CI-AKI is feasible, appears safe, and has the potential to decrease the incidence of CI-AKI specially in resource limited setting such as ours where coronary imaging by IVUS is not possible in every patient.
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Affiliation(s)
| | - Ranjit Kumar Nath
- Department of Cardiology, ABVIMS, Dr R.M.L. Hospital, New Delhi, India
| | | | | | - Ajay Raj
- Department of Cardiology, ABVIMS, Dr R.M.L. Hospital, New Delhi, India
| | - Ajay Kumar Sharma
- Department of Cardiology, ABVIMS, Dr R.M.L. Hospital, New Delhi, India
| | - Tarun Kumar
- Department of Cardiology, ABVIMS, Dr R.M.L. Hospital, New Delhi, India
| | - Dheerendra Kuber
- Department of Cardiology, ABVIMS, Dr R.M.L. Hospital, New Delhi, India
| | - Puneet Aggarwal
- Department of Cardiology, ABVIMS, Dr R.M.L. Hospital, New Delhi, India
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Gurm HS. Guarding the Kidneys: Re-Examining the Role of Prophylactic Hydration in Contemporary Interventional Practice. JACC Cardiovasc Interv 2022; 15:1649-1651. [PMID: 35907750 DOI: 10.1016/j.jcin.2022.06.030] [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: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hitinder S Gurm
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
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Claessen B, Beerkens F, Henriques JP. Vasoactive and Antiarrhythmic Drugs During PCI. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kumar P, Jino B, Roy S, Shafeeq A, Rajendran M. Absolute zero-contrast percutaneous coronary intervention under intravascular ultrasound guidance in chronic kidney disease patients – From despair to hope? IJC HEART & VASCULATURE 2022; 40:101052. [PMID: 35601526 PMCID: PMC9120254 DOI: 10.1016/j.ijcha.2022.101052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Prathap Kumar
- Corresponding author at: Meditrina Hospital, Ayathil-691021, Kollam, Kerala, India.
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Jovin IS, Warsavage TJ, Plomondon ME, Grunwald GK, Waldo SW, Rao SV, Brilakis ES, Azzalini L. Iso-osmolar versus low-osmolar contrast media and outcomes after percutaneous coronary intervention: Insights from the VA CART Program. Catheter Cardiovasc Interv 2022; 100:85-93. [PMID: 35500170 DOI: 10.1002/ccd.30218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/12/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To assess whether contrast media type is associated with outcomes in veterans undergoing percutaneous coronary intervention (PCI). BACKGROUND There is uncertainty about the impact of iso-osmolar contrast medium (IOCM) versus low-osmolar contrast medium (LOCM) on acute kidney injury (AKI) and other major adverse renal or cardiovascular events (MARCE) after PCI. We assessed the association between contrast media type and MARCE in patients who underwent PCI within the Veterans Administration Healthcare System. METHODS We reviewed PCIs performed between 2009 and 2019 using data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. The primary endpoint was MARCE, a composite of myocardial infarction, stroke, all-cause death, AKI, and dialysis onset at 30 days. RESULTS The analysis cohort consisted of 50,389 patients of whom 25,555 received LOCM and 24,834 received IOCM. There was significant variation in contrast type across sites. After adjustment for comorbidities, no significant association between contrast media type and MARCE was observed in both site-unadjusted (odds ratio [OR] for IOCM: 0.99; 95% confidence interval [CI]: 0.92-1.08; p = 0.97) and site-adjusted (OR: 1.06; 95% CI: 0.95-1.18; p = 0.30) analyses. Similar results were obtained when contrast volume was imputed or the data was subset to individuals with available contrast volume. CONCLUSION In a large cohort of veterans undergoing PCI, we found considerable site variation in the type of contrast media used but no significant association between contrast media type and the incidence of MARCE, both before and after adjustment for the site.
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Affiliation(s)
- Ion S Jovin
- Department of Medicine, McGuire VAMC, Richmond, Virginia, USA.,Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Mary E Plomondon
- VA CART Program, VHA Office of Quality and Safety, Washington, District of Columbia, USA
| | - Gary K Grunwald
- Department of Biostatistics, University of Colorado, Aurora, Colorado, USA
| | - Stephen W Waldo
- VA CART Program, VHA Office of Quality and Safety, Washington, District of Columbia, USA.,Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sunil V Rao
- The Durham VA Health System, Durham, North Carolina, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Lorenzo Azzalini
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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Tarantini G, Prasad A, Rathore S, Bansal S, Gottfried R, Rosenkranz AR, Briguori C, Yaghoubi M, Mashayekhi A, Javanbakht M, Moloney E. DyeVert Contrast Reduction System Use in Patients Undergoing Coronary and/or Peripheral Angiography: A Systematic Literature Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:841876. [PMID: 35547222 PMCID: PMC9081570 DOI: 10.3389/fmed.2022.841876] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Contrast-associated acute kidney injury (CA-AKI) is an important adverse effect associated with injecting iodinated intra-arterial contrast media (CM) during coronary angiography. The DyeVert™ Contrast Reduction System is a medical device intended to reduce the intra-arterial CM volume (CMV) administered. The aim of this study was to assess DyeVert System clinical effectiveness and safety by implementing a systematic review and meta-analysis of existing evidence. Methods Systematic electronic literature searches were conducted in MEDLINE, Embase, the Cochrane Database of Systematic Reviews, ClinicalTrials.gov, and the International Clinical Trials Registry Platform database. Relevant data were extracted from included studies and meta-analyses were performed to synthesize evidence across studies. Results The review included 17 eligible studies involving 1,731 DyeVert System cases and 1,387 control cases (without the use of DyeVert). Meta-analyses demonstrated use of the DyeVert System reduced CMV delivered to the patient by 39.27% (95% CI, 36.10-42.48%, P < 0.001), reduced CMV/baseline renal function ratios (Hedges's g, -0.56; 95% CI, -0.70 to -0.42, P < 0.001) and percentage of cases exceeding the maximum CMV threshold (risk difference -0.31, 95% CI, -0.48 to -0.13, P < 0.001) while maintaining adequate image quality in 98% of cases. DyeVert System cases demonstrated lower CA-AKI incidence vs. controls (absolute risk reduction 5.00% (95% CI, 0.40-9.80%; P = 0.03), relative risk 0.60 (95% CI, 0.40-0.90; P = 0.01) with a pooled estimate of the number needed to treat with the DyeVert System to avoid 1 CA-AKI event of 20. Conclusion DyeVert System use significantly reduces CMV delivered to the patient, CMV/baseline renal function ratios, and CA-AKI incidence while maintaining image quality. Accordingly, the device may serve as an adjunctive, procedure-based strategy to prevent CA-AKI. Future multi-center studies are needed to further assess effects of minimizing CMV on endpoints such as CA-AKI prevention, incidence of adverse cardiac and renal events, and health care costs.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Anand Prasad
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio, TX, United States
| | - Sudhir Rathore
- Frimley Health National Health Service (NHS) Foundation Trust, Camberley, United Kingdom
| | - Shweta Bansal
- Department of Medicine, Division of Nephrology, University of Texas Health Science Center, San Antonio, TX, United States
| | - Regine Gottfried
- Clinic for General and Interventional Cardiology and Angiology, Herz- und Diabeteszentrum Nordrhein-Westfalen (NRW), Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Alexander R. Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Mohsen Yaghoubi
- Mercer University College of Pharmacy, Atlanta, GA, United States
| | - Atefeh Mashayekhi
- Optimax Access Ltd., Market Access Consultancy, University of Southampton Science Park, Hampshire, United Kingdom
| | - Mehdi Javanbakht
- Optimax Access Ltd., Market Access Consultancy, University of Southampton Science Park, Hampshire, United Kingdom
- Device Access UK Ltd., Market Access Consultancy, University of Southampton Science Park, Hampshire, United Kingdom
| | - Eoin Moloney
- Optimax Access Ltd., Market Access Consultancy, University of Southampton Science Park, Hampshire, United Kingdom
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Ragosta M. That "Bump" in Creatinine Post-PCI Might "Bump Off" Your Patient: Can We Prevent This? JACC Cardiovasc Interv 2022; 15:767-769. [PMID: 35305905 DOI: 10.1016/j.jcin.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Ragosta
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
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41
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Ezhumalai B. The Principles of Ultra-Low Contrast Percutaneous Coronary Intervention. Indian Heart J 2022; 74:258-259. [PMID: 35427628 PMCID: PMC9243625 DOI: 10.1016/j.ihj.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/21/2022] [Accepted: 04/09/2022] [Indexed: 10/31/2022] Open
Abstract
Ultra-low contrast percutaneous coronary intervention (ULCPCI) can be performed electively in advanced chronic kidney disease. Engage guide catheter and advance guidewire into the coronary artery without using contrast. IVUS-guided PCI can reduce the contrast load. Perform co-registration of distal and proximal radio-opaque marker bands of intravascular ultrasound (IVUS) catheter. Deploy the stent at the target lesion under fluoroscopic guidance of these co-registered position of the IVUS-marking images. Complete the ULCPCI procedure with a final angiography using minimal contrast. Newer contrast sparing techniques and intravascular imaging technologies provide opportunities to perform ULCPCI efficiently with good results and the least complications.
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Azzalini L, Karmpaliotis D, Santiago R, Mashayekhi K, Di Mario C, Rinfret S, Nicholson WJ, Carlino M, Yamane M, Tsuchikane E, Brilakis ES. Contemporary Issues in Chronic Total Occlusion Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2022; 15:1-21. [PMID: 34991814 DOI: 10.1016/j.jcin.2021.09.027] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 12/18/2022]
Abstract
Remarkable progress has been achieved in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in recent years, with refinement of the indications and technical aspects of the procedure, imaging, and complication management. Randomized controlled trials and rigorous prospective registries have provided high-quality data on the benefits and risks of CTO PCI. Global collaboration has led to an agreement on nomenclature, indications, endpoint definition, and principles of clinical trial design that have been distilled in global consensus documents such as the CTO Academic Research Consortium. Increased use of preprocedural coronary computed tomography angiography and intraprocedural intravascular imaging, as well as development of novel techniques and structured CTO crossing and complication management algorithms, allow a systematic, stepwise approach to this difficult lesion subset. This state-of-the-art review provides a comprehensive discussion about the most recent developments in the indications, preprocedural planning, technical aspects, complication management, and future directions of CTO PCI.
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Affiliation(s)
- Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
| | - Dimitri Karmpaliotis
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Ricardo Santiago
- PCI Cardiology Group, Bayamon Heart and Lung Institute, Bayamon, Puerto Rico, USA
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Department of Clinical & Experimental Medicine, Florence, Italy
| | | | | | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Masahisa Yamane
- Cardiovascular Division, Saitama-Sekishinkai Hospital, Saitama, Japan
| | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Li Z, Liu B, Li D, Jia Y, Ye L, Liao X, Zeng Z, Wan Z. Relationship between Braden Scale scores and acute kidney injury among patients with acute coronary syndrome: a multicentre retrospective cohort study. BMJ Open 2022; 12:e049102. [PMID: 34987039 PMCID: PMC8734026 DOI: 10.1136/bmjopen-2021-049102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To evaluate the impact of pressure ulcer events assessed by the Braden Scale (BS) on acute kidney injury (AKI) in patients with acute coronary syndrome (ACS). DESIGN A multicentre retrospective cohort study. SETTING Chest pain centres from seven tertiary hospitals in China. PARTICIPANTS We analysed 3185 patients with ACS from the Retrospective Evaluation of Acute Chest Pain study. The patients were divided into three groups (B1, B2 and B3) according to their BS scores (≤12 vs 13-14 vs ≥15, respectively) at admission. OUTCOME MEASURES AKI was defined according to the criteria of the 2012 Kidney Disease: Improving Global Outcomes. Multivariate logistic analysis was used to evaluate the relationship between the BS score and AKI. RESULTS There were 461 patients (14.5%) with ACS who had the complication of AKI. Patients with a lower score on the BS had a higher incidence of AKI (p<0.001). Multivariate logistic regression analysis showed that adjusted ORs of the BS score for AKI were 2.242 (B1 vs B3: 95% CI: 1.643 to 3.060, p<0.001) and 1.566 (B2 vs B3: 95% CI: 1.186 to 2.069, p=0.002). The receiver operating characteristic curve analysis showed that the area under the curve of the BS score was 0.719 (95% CI: 0.702 to 0.736; p<0.001) for AKI. CONCLUSIONS The BS score was independently associated with AKI. It may be a useful tool to identify those who may benefit from further prediction and prevention of AKI in patients with ACS. TRAIL REGISTRATION NUMBER ChiCTR1900024657 (http://www.chictr.org.cn/). The satge rekates to results.
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Affiliation(s)
- Zhichao Li
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Bofu Liu
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Dongze Li
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Jia
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Ye
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- Department of General Practice and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi Zeng
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi Wan
- Department of Emergency Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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De Rosa R, Morici N, De Servi S, De Luca G, Galasso G, Piscione F, Ferri LA, Piatti L, Grosseto D, Tortorella G, Franco N, Lenatti L, Misuraca L, Leuzzi C, Verdoia M, Sganzerla P, Cacucci M, Ferrario M, Murena E, Sibilio G, Toso A, Savonitto S. Impact of renal dysfunction and acute kidney injury on outcome in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:1160–1169. [PMID: 32374175 DOI: 10.1177/2048872620920475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/30/2020] [Indexed: 02/24/2024]
Abstract
BACKGROUND Chronic kidney disease is common in patients admitted with acute coronary syndrome and its prevalence dramatically increases with age. Understanding the determinants of adverse outcomes in this extremely high-risk population may be useful for the development of specific treatment strategies and planning of secondary prevention modalities. AIM The aim of this study was to assess the impact of baseline renal function and acute kidney injury on one-year outcome of elderly patients with acute coronary syndrome treated with percutaneous coronary intervention. METHODS Patients aged 75 years and older with acute coronary syndrome undergoing successful percutaneous coronary intervention were selected among those enrolled in three Italian multicentre studies. Based on the baseline estimated glomerular filtration rate (eGFR) calculated using the Cockcroft-Gault formula ([(140-age) × body weight × 0.85 if female]/(72 × serum creatinine)* 1.73 m2 of body surface area), patients were classified as having none or mild (eGFR ≥60 ml/min/1.73 m2), moderate (eGFR 30-59 ml/min/1.73 m2) or severe (eGFR <30 ml/min/1.73 m2) renal dysfunction. Acute kidney injury was defined according to the Acute Kidney Injury Network classification. All-cause and cardiovascular mortality, non-fatal myocardial infarction, rehospitalisation for cardiovascular causes, stroke and type 2, 3 and 5 Bleeding Academic Research Consortium bleedings were analysed up to 12 months. RESULTS A total of 1904 patients were included. Of these, 57% had moderate and 11% severe renal dysfunction. At 12 months, patients with renal dysfunction had higher rates (P < 0.001) of all-cause (4.5%, 7.5% and 17.8% in patients with none or mild, moderate and severe renal dysfunction, respectively) and cardiovascular mortality (2.8%, 5.2% and 10.2%, respectively). After multivariable adjustment, severe renal dysfunction was associated with a higher risk of all-cause (hazard ratio (HR) 2.86, 95% confidence interval (CI) 1.52-5.37, P = 0.001) and cardiovascular death (HR 3.11, 95% CI 1.41-6.83, P = 0.005), whereas non-fatal events were unaffected. Acute kidney injury incidence was significantly higher in ST-elevation myocardial infarction versus non-ST-elevation acute coronary syndrome patients (11.7% vs. 7.8%, P = 0.036) and in those with reduced baseline renal function (P < 0.001), and it was associated with increased mortality independently from baseline renal function and clinical presentation. CONCLUSIONS Baseline renal dysfunction is highly prevalent and is associated with higher mortality in elderly acute coronary syndrome patients undergoing percutaneous coronary intervention. Acute kidney injury occurs more frequently among ST-elevation myocardial infarction patients and those with pre-existing renal dysfunction and is independently associated with one-year mortality.
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Affiliation(s)
- Roberta De Rosa
- Cardiovascular and Thoracic Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Italy
| | - Nuccia Morici
- Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
| | | | - Giuseppe De Luca
- Azienda Ospedaliera Universitaria Maggiore della Carità, Eastern Piedmont University, Italy
| | - Gennaro Galasso
- Cardiovascular and Thoracic Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Italy
| | - Federico Piscione
- Cardiovascular and Thoracic Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Italy
| | - Luca A Ferri
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Italy
| | | | | | | | | | | | | | - Chiara Leuzzi
- Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Italy
| | - Monica Verdoia
- Azienda Ospedaliera Universitaria Maggiore della Carità, Eastern Piedmont University, Italy
| | - Paolo Sganzerla
- Division of Cardiology, ASST Bergamo ovest-ospedale di Treviglio, Italy
| | | | - Maurizio Ferrario
- Division of Cardiology, IRCCS Fondazione Policlinico S Matteo, Italy
| | - Ernesto Murena
- Division of Cardiology, Ospedale S Maria delle Grazie, Italy
| | | | - Anna Toso
- Division of Cardiology, Ospedale S Stefano, Italy
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Acute kidney injury and in-hospital mortality in patients with ST-elevation myocardial infarction of different age groups. Int J Cardiol 2021; 344:8-12. [PMID: 34537309 DOI: 10.1016/j.ijcard.2021.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a well-known complication of ST-elevation acute myocardial infarction (STEMI) with an adverse impact on prognosis. Since AKI develops more frequently in elderly patients, we hypothesized that its higher incidence in older STEMI patients might explain their increased in-hospital mortality. We assessed the relationship between AKI and in-hospital mortality in patients with STEMI of different age groups. METHODS We retrospectively evaluated 5136 STEMI patients treated with primary percutaneous coronary intervention (pPCI). We defined AKI as ≥0.5 mg/dl creatinine increase in the first 72 h. Patients were grouped according to age (<75 [n = 4040] or ≥ 75 [n = 1096] years). The primary endpoint was in-hospital mortality. RESULTS The incidence of AKI was 7%. It was 4.6% in patients <75 years and 15.1% in those ≥75 years (P < 0.0001). The overall in-hospital mortality was 4%. It was 2.6% and 8.5% in patients younger and older than 75 years, respectively (P < 0.0001). It was higher in AKI than in non-AKI patients, both in the overall population (27% vs. 2%) and in the two age groups (25% vs. 2% and 29% vs. 5% in younger and older patients, respectively; P < 0.0001). The adjusted odds ratio of in-hospital mortality associated with AKI progressively decreased in parallel with increasing age decades (from 24.7 [95% CI 11.2-54.1] in patients <65 years to 3.9 [95% CI 1.6-9.7] in those >85 years). CONCLUSIONS In STEMI patients treated with pPCI, AKI incidence and in-hospital mortality steadily increase with age. However, the prognostic impact of AKI is progressively reduced as age increases.
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Mo H, Ye F, Chen D, Wang Q, Liu R, Zhang P, Xu Y, Cheng X, Mei Z, Zheng Y, Dai Y, Jiang S, Ge J. A Predictive Model Based on a New CI-AKI Definition to Predict Contrast Induced Nephropathy in Patients With Coronary Artery Disease With Relatively Normal Renal Function. Front Cardiovasc Med 2021; 8:762576. [PMID: 34778413 PMCID: PMC8581221 DOI: 10.3389/fcvm.2021.762576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/04/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Contrast induced nephropathy (CIN) is a common complication in patients receiving intravascular contrast media. In 2020, the American College of Radiology and the National Kidney Foundation issued a new contrast induced acute kidney injury (CI-AKI) criteria. Therefore, we aimed to explore the potential risk factors for CIN under the new criteria, and develop a predictive model for patients with coronary artery disease (CAD) with relatively normal renal function (NRF). Methods: Patients undergoing coronary angiography or percutaneous coronary intervention at Zhongshan Hospital, Fudan University between May 2019 and April 2020 were consecutively enrolled. Eligible candidates were selected for statistical analysis. Univariate and multivariate logistic regression analyses were used to identify the predictive factors. A stepwise method and a machine learning (ML) method were used to construct a model based on the Akaike information criterion. The performance of our model was evaluated using the area under the receiver operating characteristic curves (AUC) and calibration curves. The model was further simplified into a risk score. Results: A total of 2,009 patients with complete information were included in the final statistical analysis. The results showed that the incidence of CIN was 3.2 and 1.2% under the old and new criteria, respectively. Three independent predictors were identified: baseline uric acid level, creatine kinase-MB level, and log (N-terminal pro-brain natriuretic peptide) level. Our stepwise model had an AUC of 0.816, which was higher than that of the ML model (AUC = 0.668, P = 0.09). The model also achieved accurate predictions regarding calibration. A risk score was then developed, and patients were divided into two risk groups: low risk (total score < 10) and high risk (total score ≥ 10). Conclusions: In this study, we first identified important predictors of CIN in patients with CAD with NRF. We then developed the first CI-AKI model on the basis of the new criteria, which exhibited accurate predictive performance. The simplified risk score may be useful in clinical practice to identify high-risk patients.
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Affiliation(s)
- Hanjun Mo
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fang Ye
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Danxia Chen
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qizhe Wang
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ru Liu
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Panpan Zhang
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yaxin Xu
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xuelin Cheng
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhendong Mei
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Fudan University, Shanghai, China
| | - Yan Zheng
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Human Phenome Institute, Fudan University, Shanghai, China.,Department of Cardiology, Zhongshan Hospital, National Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Disease, Shanghai, China.,Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China
| | - Yuxiang Dai
- Department of Cardiology, Zhongshan Hospital, National Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Sunfang Jiang
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China.,Health Management Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, National Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Disease, Shanghai, China
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47
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Shah A, Bazemore T, Wolf H, Yang H, Liu Y, Stouffer GA. Length of Preprocedure Fasting Was Associated With Contrast Associated-Acute Kidney Injury in High-Risk Patients Undergoing Coronary Angiography. Am J Cardiol 2021; 159:1-7. [PMID: 34656310 DOI: 10.1016/j.amjcard.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
Hydration is recommended to prevent contrast associated-acute kidney injury (CA-AKI) but interactions between blood pressure, left ventricular end diastolic pressure (LVEDP) and hydration status on CA-AKI are incompletely understood. This analysis presents the results of a single-center prospective study of patients undergoing coronary angiography with a predicted risk of CA-AKI >14%. 146 patients were enrolled with a mean (±SD) age of 71 ± 11 years; 94 (64.4%) were men, 142 (97.3%) had hypertension, 96 (65.8%) had diabetes mellitus and the mean (SD) serum creatinine was 1.21 ± 0.36 mg/dl. CA-AKI occurred in 31 (21%) patients. There were no significant differences in demographics, comorbidities, renal function, LVEDP, systolic blood pressure, diastolic blood pressure, heart rate, mean arterial pressure or pulse pressure in patients who developed versus those who did not develop CA-AKI. There was no association between the amount of peri-procedure intravenous fluids and change in creatinine postprocedure. In multivariate analysis, hemoglobin, the time that the patient was fasting from solids (NPO time), and contrast volume were associated with the development of CA-AKI. There was a highly significant interaction (p = 0.0028) between the amount of intravenous fluids, NPO time and contrast volume and changes in postprocedure creatinine. In summary, hemoglobin, NPO time and contrast volume, but not hemodynamic variables, correlated with worsening renal function following coronary angiography in this population of high-risk patients. Results suggested that intravenous hydration is important in subgroups of patients depending on NPO time and contrast volume.
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Affiliation(s)
- Anand Shah
- Department of Medicine, Duke University, Durham, North Carolina
| | - Taylor Bazemore
- Division of Cardiology and the McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Hope Wolf
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Hannan Yang
- Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Yan Liu
- Division of Cardiology, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - George A Stouffer
- Division of Cardiology and the McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina.
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48
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Jung RG, Di Santo P, Mathew R, Abdel-Razek O, Parlow S, Simard T, Marbach JA, Gillmore T, Mao B, Bernick J, Theriault-Lauzier P, Fu A, Lau L, Motazedian P, Russo JJ, Labinaz M, Hibbert B. Implications of Myocardial Infarction on Management and Outcome in Cardiogenic Shock. J Am Heart Assoc 2021; 10:e021570. [PMID: 34713704 PMCID: PMC8751815 DOI: 10.1161/jaha.121.021570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The randomized DOREMI (Dobutamine Compared to Milrinone) clinical trial evaluated the efficacy and safety of milrinone and dobutamine in patients with cardiogenic shock. Whether the results remain consistent when stratified by acute myocardial infarction remains unknown. In this substudy, we sought to evaluate differences in clinical management and outcomes of acute myocardial infarction complicated by cardiogenic shock (AMICS) versus non-AMICS. Methods and Results Patients in cardiogenic shock (n=192) were randomized 1:1 to dobutamine or milrinone. The primary composite end point in this subgroup analysis was all-cause in-hospital mortality, cardiac arrest, non-fatal myocardial infarction, cerebrovascular accident, the need for mechanical circulatory support, or initiation of renal replacement therapy (RRT) at 30-days. Outcomes were evaluated in patients with (n=65) and without (n=127) AMICS. The primary composite end point was significantly higher in AMICS versus non-AMICS (hazard ratio [HR], 2.21; 95% CI, 1.47-3.30; P=0.0001). The primary end point was driven by increased rates of all-cause mortality, mechanical circulatory support, and RRT. No differences in other secondary outcomes including cardiac arrest or cerebrovascular accident were observed. AMICS remained associated with the primary composite outcome, 30-day mortality, and RRT after adjustment for age, sex, procedural contrast use, multivessel disease, and inotrope type. Conclusions AMI was associated with increased rates of adverse clinical outcomes in cardiogenic shock along with increased rates of mortality and initiation of mechanical circulatory support and RRT. Contrast administration during revascularization likely contributes to increased rates of RRT. Heterogeneity of outcomes in AMICS versus non-AMICS highlights the need to study interventions in specific subgroups of cardiogenic shock. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03207165.
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Affiliation(s)
- Richard G Jung
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Faculty of Medicine University of Ottawa Ontario Canada.,Department of Cellular and Molecular Medicine University of Ottawa Ontario Canada
| | - Pietro Di Santo
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,School of Epidemiology and Public Health University of Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Rebecca Mathew
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Critical Care Department of Medicine University of Ottawa Ontario Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Simon Parlow
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Trevor Simard
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Department of Cellular and Molecular Medicine University of Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Jeffrey A Marbach
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Critical Care Tufts Medical Center Boston MA
| | | | - Brennan Mao
- Faculty of Medicine University of Ottawa Ontario Canada
| | - Jordan Bernick
- Cardiovascular Research Methods Centre University of Ottawa Heart Institute Ottawa Canada
| | - Pascal Theriault-Lauzier
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Angel Fu
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Lawrence Lau
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | | | - Juan J Russo
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Marino Labinaz
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Benjamin Hibbert
- CAPITAL Research Group Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada.,Department of Cellular and Molecular Medicine University of Ottawa Ontario Canada.,School of Epidemiology and Public Health University of Ottawa Ontario Canada.,Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
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49
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Patel B, Assaf O, Nabi A, Wiper A, More R, Abdelaziz HK, Choudhury T. Ultra-low contrast, complex left main coronary intervention case series using novel intravascular ultrasound technology. Eur Heart J Case Rep 2021; 5:ytab398. [PMID: 34870084 PMCID: PMC8637793 DOI: 10.1093/ehjcr/ytab398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/08/2021] [Accepted: 09/30/2021] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) carries a high morbidity and mortality. Ultra-low contrast percutaneous coronary intervention (ULPCI) has previously been described. Complex left main (LM) ULPCI using two-stent strategy guided by novel intravascular ultrasound (IVUS) co-registration software has not been described. We report a series of complex LM ULPCI using IVUS co-registration.
Case Summaries
Five patients with estimated glomerular filtration rate ≤20 mL/min who presented with stable angina or non-ST segment elevation acute coronary syndrome underwent percutaneous coronary intervention (PCI). The patients previously had diagnostic angiography performed as a separate procedure. Successful LM ULPCI was performed in all patients with a provisional and two-stent bifurcation strategies. These were complex procedures, some of which required haemodynamic support and rotational atherectomy.
Discussion
This report describes the first ULPCI using a dedicated two-stent LM bifurcation strategy and using rotational atherectomy and IVUS co-registration. This technology facilitated complex PCI in this high-risk patient group with minimal contrast use (≤6 mL) with optimal results and no patients developed acute kidney injury after intervention. The adaptation of ULPCI to daily practice in patients at risk of CIN will improve treatment for this underserved patient group.
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Affiliation(s)
- Billal Patel
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Whinney Heys Road, Blackpool FY3 8NR, UK
| | - Omar Assaf
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Whinney Heys Road, Blackpool FY3 8NR, UK
| | - Amjad Nabi
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Whinney Heys Road, Blackpool FY3 8NR, UK
| | - Andrew Wiper
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Whinney Heys Road, Blackpool FY3 8NR, UK
| | - Ranjit More
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Whinney Heys Road, Blackpool FY3 8NR, UK
| | - Hesham K Abdelaziz
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Whinney Heys Road, Blackpool FY3 8NR, UK
| | - Tawfiq Choudhury
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Whinney Heys Road, Blackpool FY3 8NR, UK
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50
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Atrial Fibrillation and Chronic Kidney Disease-A Risky Combination for Post-Contrast Acute Kidney Injury. J Clin Med 2021; 10:jcm10184140. [PMID: 34575257 PMCID: PMC8471797 DOI: 10.3390/jcm10184140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/05/2021] [Accepted: 09/10/2021] [Indexed: 12/30/2022] Open
Abstract
Atrial fibrillation (AF) symptoms may mimic coronary artery disease (CAD) which reflects the difficulties in qualifying AF patients for invasive diagnostics. A substantial number of coronary angiographies may be unnecessary or even put patients at risk of post-contrast acute kidney injury (PC-AKI), especially patients with chronic kidney disease (CKD). We aimed to investigate the hypothesis indicating higher prevalence of PC-AKI in patients with AF scheduled for coronary angiography. The study population comprised of 8026 patients referred for elective coronarography including 1621 with AF. In the comparison of prevalence of PC-AKI in distinguished groups we can see that kidney impairment was twice more frequent in patients with AF in both groups with CKD (CKD (+)/AF (+) 6.24% vs. CKD (+)/AF (−) 3.04%) and without CKD (CKD (−)/AF (+) 2.32% vs. CKD (−)/AF (−) 1.22%). In our study, post-contrast acute kidney disease is twice more frequent in patients with AF, especially in subgroup with chronic kidney disease scheduled for coronary angiography. Additionally, having in mind results of previous studies stating that AF is associated with non-obstructive coronary lesions on angiography, patients with AF and CKD may be unnecessarily exposed to contrast agent and possible complications.
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