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Ye J, Liu C, Deng Z, Zhu Y, Zhang S. Risk factors associated with contrast-associated acute kidney injury in ST-segment elevation myocardial infarction patients: a systematic review and meta-analysis. BMJ Open 2023; 13:e070561. [PMID: 37380206 PMCID: PMC10410875 DOI: 10.1136/bmjopen-2022-070561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/13/2023] [Indexed: 06/30/2023] Open
Abstract
OBJECTIVE The objective of this systematic review and meta-analysis was to evaluate the risk factors for contrast-associated acute kidney injury (CA-AKI) in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched the databases of PubMed, Embase and Ovid, up to February 2022, for observational studies that investigated the association between risk factors and CA-AKI. RESULTS A total of 21 studies were included in the meta-analysis. Of the total 22 015 participants, 2728 developed CA-AKI. Pooled incidence was 11.91% (95% CI 9.69%, 14.14%). Patients with CA-AKI were more likely to be older, female, also had comorbidities (hypertension, diabetes, previous heart failure). Smoking (OR: 0.60; 95% CI 0.52, 0.69) and family history of CAD (coronary artery disease) (OR: 0.76; 95% CI 0.60, 0.95) were associated with lower risk of CA-AKI. Left anterior descending (LAD) artery occlusion (OR: 1.39; 95% CI 1.21, 1.59), left main disease (OR: 4.62; 95% CI 2.24, 9.53) and multivessel coronary disease (OR: 1.33; 95% CI 1.11, 1.60) were risk factors for CA-AKI. Contrast volume (weighted mean difference: 20.40; 95% CI 11.02, 29.79) was associated with increased risk in patients receiving iso-osmolar or low-osmolar non-ionic contrast. CONCLUSIONS In addition to the known risk factors, LAD artery infarction, left main disease and multivessel disease are risk factors for CA-AKI. The unexpected favourable association between smoking, as well as family history of CAD, and CA-AKI requires further investigation. PROSPERO REGISTRATION NUMBER CRD42021289868.
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Affiliation(s)
- Jiahao Ye
- Department of Cardiology, Guangzhou Red Cross Hospital, Guangzhou, Guangdong Province, China
| | - Chaoyun Liu
- Department of Cardiology, Guangzhou Red Cross Hospital, Guangzhou, Guangdong Province, China
| | - Zhanyu Deng
- Department of Cardiology, Guangzhou Red Cross Hospital, Guangzhou, Guangdong Province, China
| | - Youfeng Zhu
- Department Of Intensive Care Unit, Guangzhou Red Cross Hospital, Guangzhou, Guangdong Province, China
| | - Shaoheng Zhang
- Department of Cardiology, Guangzhou Red Cross Hospital, Guangzhou, Guangdong Province, China
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Lao Y, Chen K, Feng L, Yuan Y, Zhang J, Zhang L, Huang X, Li M, Wu Z, Bin J, Liao Y. Delayed PCI is not beneficial for STEMI patients with impaired renal function: a retrospective cohort study. BMC Cardiovasc Disord 2023; 23:263. [PMID: 37208590 DOI: 10.1186/s12872-023-03271-2] [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: 09/19/2022] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Preexisting impaired renal function (IRF) and contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) are important prognostic parameters, but it is unknown whether delayed PCI is still beneficial for STEMI patients with IRF. METHODS A retrospective single-center cohort study was performed in 164 patients who presented at least 12 h after symptom onset, and were diagnosed with STEMI and IRF. They were assigned to two groups to receive PCI plus optimal medical therapy (OMT) and OMT alone respectively. Clinical outcomes at 30 days and 1 year were compared between two groups, and hazard ratio for survival was analyzed using Cox regression model. A power analysis demanded 34 patients in each group to produce a power of 90% and a P value of 0.05. RESULTS The 30-day mortality was significantly lower in PCI group (n = 126) than in non-PCI group (n = 38) (11.1% versus 28.9%, P = 0.018), while there was no significant difference in the 1-year mortality and incidence of cardiovascular comorbidities between the two groups. Cox regression analysis showed that patients with IRF didn't benefit from receiving PCI on survival rate (P = 0.267). CONCLUSIONS Delayed PCI is not beneficial on one-year clinical outcomes for STEMI patients with IRF.
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Affiliation(s)
- Yi Lao
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Heart Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong province, China
| | - Kaitong Chen
- Cardiovascular Department, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong Province, China.
| | - Li Feng
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Yong Yuan
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Jin Zhang
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Liting Zhang
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Xuansheng Huang
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Mingxing Li
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Zidi Wu
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Jianping Bin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Heart Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong province, China
| | - Yulin Liao
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Heart Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong province, China.
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3
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He HM, He C, You ZB, Zhang SC, Lin XQ, Luo MQ, Lin MQ, Zhang LW, Lin KY, Guo YS. Non-Invasive Liver Fibrosis Scores Are Associated With Contrast-Associated Acute Kidney Injury in Patients Undergoing Elective Percutaneous Coronary Intervention. Angiology 2023; 74:333-343. [PMID: 35642134 DOI: 10.1177/00033197221105745] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies have demonstrated that non-invasive liver fibrosis scores (LFSs) are associated with kidney function deterioration. This study aimed to assess the predictive performance of LFSs in contrast-associated acute kidney injury (CA-AKI) in coronary artery disease (CAD) patients undergoing elective percutaneous coronary intervention (PCI). This retrospective study involved 5627 patients. The frequency of CA-AKI was 6.3% (n = 353). In a multivariate logistic analysis after adjustment, non-invasive LFSs, including fibrosis-5 score (FIB-5), fibrosis-4 score (FIB-4), aspartate aminotransferase to alanine aminotransferase ratio (AAR), and aspartate aminotransferase to platelet ratio index were independent risk factors for CA-AKI (all P < .05), whereas the Forns score was not (P > .05). The highest predictive performance was observed for FIB-5 (area under the curve [AUC] = .644) compared to other LFSs. A restricted cubic spline analysis confirmed approximately linear relationships between LFSs and risks of CA-AKI. Furthermore, adding FIB-5 (AUC = .747; net reclassification improvement [NRI] = .441, P < .001; integrated discrimination improvement [IDI] = .008, P < .001) or AAR (AUC = .747; NRI = .419, P < .001; IDI = .006, P = .010) to an established clinical risk model could significantly improve the prediction of CA-AKI. The LFSs were significantly associated with CA-AKI, possibly serving as predictive tools for early identification of CAD patients undergoing elective PCI that are at high risk of CA-AKI.
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Affiliation(s)
- Hao-Ming He
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Chen He
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Zhe-Bin You
- Department of Geriatric Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fuzhou, China
| | - Si-Cheng Zhang
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Xue-Qin Lin
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Man-Qing Luo
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Mao-Qing Lin
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Li-Wei Zhang
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Kai-Yang Lin
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Yan-Song Guo
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
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4
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Ozbeyaz NB, Gokalp G, Algul E, Sahan HF, Aydinyilmaz F, Guliyev I, Kalkan K. H 2FPEF Score and Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Angiology 2023; 74:181-188. [PMID: 35503102 DOI: 10.1177/00033197221099425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Contrast-induced nephropathy (CIN) is one of the most common complications associated with coronary angiography and percutaneous coronary intervention (PCI). This study evaluated the relationship between the H2FPEF (obesity (H), hypertension(H), atrial fibrillation (F), pulmonary hypertension (P), an age >60 years (E), and E/e' > 9 (F)) score which is used to diagnose heart failure with preserved ejection fraction and CIN. Patients (n = 1346) who underwent PCI for acute coronary syndrome (ACS) between December 2018 and January 2021 were retrospectively included. Contrast-induced nephropathy patients had significantly higher H2FPEF scores (4.10 ± 1.92 vs 2.28 ± 1.56, P < .001). In addition, the H2FPEF score was found to be an independent risk factor for the development of CIN (Odd Ratio 1.633 95% CI (1.473-1.811), P < .001) together with age, diabetes mellitus, systolic pulmonary arterial pressure, and left anterior descending as an infarct-related artery. According to point biserial correlation analysis, CIN and H2FPEF score have a strong correlation (rpb = .376, P < .001). The receiver operating characteristic curve showed the optimal cutoff value of the H2FPEF score to predict the development of CIN was 2.5, with 79.8% sensitivity and 64.1% specificity. In conclusion, the H2FPEF score may predict the development of CIN in patients presenting with ACS and undergoing PCI.
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Affiliation(s)
- Nail Burak Ozbeyaz
- Pursaklar State Hospital, 37511Department of Cardiology Clinic, Ankara, Turkey
| | - Gokhan Gokalp
- Pursaklar State Hospital, 37511Department of Cardiology Clinic, Ankara, Turkey
| | - Engin Algul
- University of Health Sciences, 146992Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Haluk Furkan Sahan
- University of Health Sciences, 146992Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Faruk Aydinyilmaz
- Department of Cardiology, 215289Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Ilkin Guliyev
- Department of Cardiology, 37511Medical Park Hospital, Tokat, Turkey
| | - Kamuran Kalkan
- University of Health Sciences, 146992Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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5
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Qiu H, Zhu Y, Shen G, Wang Z, Li W. A Predictive Model for Contrast-Induced Acute Kidney Injury After Percutaneous Coronary Intervention in Elderly Patients with ST-Segment Elevation Myocardial Infarction. Clin Interv Aging 2023; 18:453-465. [PMID: 36987461 PMCID: PMC10040169 DOI: 10.2147/cia.s402408] [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: 01/09/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Purpose Development and validation of a nomogram model to predict the risk of Contrast-Induced Acute Kidney Injury (CI-AKI) after emergency percutaneous coronary intervention (PCI) in elderly patients with acute ST-segment elevation myocardial infarction (STEMI). Patients and Methods Retrospective analysis of 542 elderly (≥65 years) STEMI patients undergoing emergency PCI in our hospital from January 2019 to June 2022, with all patients randomized to the training cohort (70%; n=380) and the validation cohort (30%; n=162). Univariate analysis, LASSO regression, and multivariate logistic regression analysis were used to determine independent risk factors for developing CI-AKI in elderly STEMI patients. R software is used to generate a nomogram model. The predictive power of the nomogram model was compared with the Mehran score 2. The area under the ROC curve (AUC), calibration curves, and decision curve analysis (DCA) was used to evaluate the prediction model's discrimination, calibration, and clinical validity, respectively. Results The nomogram model consisted of five variables: diabetes mellitus (DM), left ventricular ejection fraction (LVEF), Systemic immune-inflammatory index (SII), N-terminal pro-brain natriuretic peptide (NT-proBNP), and highly sensitive C-reactive protein(hsCRP). In the training cohort, the AUC is 0.84 (95% CI: 0.790-0.890), and in the validation cohort, it is 0.844 (95% CI: 0.762-0.926). The nomogram model has better predictive ability than Mehran score 2. Based on the calibration curves, the predicted and observed values of the nomogram model were in good agreement between the training and validation cohort. Decision curve analysis (DCA) and clinical impact curve showed that the nomogram prediction model has good clinical utility. Conclusion The established nomogram model can intuitively and specifically screen high-risk groups with a high degree of discrimination and accuracy and has a specific predictive value for CI-AKI occurrence in elderly STEMI patients after PCI.
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Affiliation(s)
- Hang Qiu
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Yinghua Zhu
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Guoqi Shen
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Zhen Wang
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Wenhua Li
- Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Correspondence: Wenhua Li, Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China, Tel +86 18052268293, Email
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6
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Kumar R, Ahmed Khan K, Rai L, Ahmed Solangi B, Ammar A, Nauman Khan M, Ahmed I, Ahmed B, Saghir T, Akbar Sial J, Karim M. Comparative analysis of four established risk scores for predicting contrast induced acute kidney injury after primary percutaneous coronary interventions. IJC HEART & VASCULATURE 2021; 37:100905. [PMID: 34765719 PMCID: PMC8569474 DOI: 10.1016/j.ijcha.2021.100905] [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: 10/11/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022]
Abstract
Objectives This study aimed to compare Mehran Risk Score (MRS) with three well -known scoring systems namely CHA2DS2-VASc score, Canada Acute Coronary Syndrome Risk Score (C-ACS), and Thrombolysis in Myocardial Infarction risk index (TRI) to predict the contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention (PCI). Background CI-AKI is a common complication after primary PCI associated with an adverse prognosis. Methods In this study consecutive patients of primary PCI were included. Patients with chronic kidney diseases, exposure to the contrast medium within the past 7 days, and Killip class IV at presentation were excluded. MRS along with three risk scores namely CHA2DS2-VASc, C-ACS, and TRI were calculated for all patients and CI-AKI was defined as either 0.5 mg/dL or 25% relative increase in post-procedure serum creatinine. The area under the curve (AUC) curve was reported. Results Post primary PCI CI-AKI was observed in 63 (9.1%) patients out of 691 patients. The AUC was 0.745 [0.679-0.810] for MRS, 0.725 [0.662-0.788] for CHA2DS2-VASc, 0.671 [0.593-0.749] for C-ACS, and 0.734 [0.674-0.795] for TRI. Sensitivity and specificity were 61.9% [48.8-73.8%] and 76.0% [72.4-79.3%] for MRS ≥ 6.5, 66.7% [53.7-78.0%] and 66.7% [62.9-70.4%] for CHA2DS2-VASc ≥ 2, 52.4% [39.4-65.1%] and 79.9% [76.6-83.0%] for C-ACS ≥ 1, and 87.3% [76.5-94.4%] and 49.2% [45.2-53.2%] for TRI ≥ 16 respectively. Conclusions The MRS has shown higher discriminating power than CHA2DS2-VASc, C-ACS, and TRI. However, the TRI can be of good value in clinical practice due to its simplicity and high sensitivity in detecting patients at higher risk of CI-AKI after primary PCI.
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Affiliation(s)
- Rajesh Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Kamran Ahmed Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Lajpat Rai
- National Institute of Cardiovascular Diseases (NICVD), Hyderabad, Pakistan
| | | | - Ali Ammar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Ifikhar Ahmed
- National Institute of Cardiovascular Diseases (NICVD), Hyderabad, Pakistan
| | - Bilal Ahmed
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Wei W, Zhang L, Zhang Y, Tang R, Zhao M, Huang Z, Liu J, Xu D, He Y, Wang B, Huang H, Li Q, Lin M, Liu Y, Chen K, Chen S. Predictive value of creatine kinase MB for contrast-induced acute kidney injury among myocardial infarction patients. BMC Cardiovasc Disord 2021; 21:337. [PMID: 34256723 PMCID: PMC8276394 DOI: 10.1186/s12872-021-02155-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background Predictive value of creatine kinase MB (CK-MB) for contrast-induced acute kidney injury (CI-AKI) among myocardial infarction (MI) patients has rarely been reported. We aim to evaluate the predictive value of CK-MB for CI-AKI among MI patients. Methods Totally, 1131 MI patients were included from the REduction of rIsk for Contrast-Induced Nephropathy (REICIN) study. The peak CK-MB before coronary angiography (CAG) was chosen. The study population was divided into two groups by log-transformed CK-MB cut-off point. The association between CK-MB and CI-AKI was tested by multivariable logistic regression. CK-MB was integrated with Age, creatinine and ejection fraction (ACEF) score and Mehran risk score (MRS) to evaluate the additive value of CK-MB. The integrated models were validated internally by the bootstrap method and externally by the PREdictive Value of COntrast voluMe to creatinine Clearance Ratio (PRECOMIN) study data set. Results Overall, 62(5.48%) patients developed CI-AKI, patients with CK-MB point > 4.7 displayed a higher incidence of CI-AKI than those without (11.9% vs. 4.0%, p < 0.001). CK-MB point > 4.7 was independently associated with CI-AKI (adjusted OR: 3.40, 95% CI: 1.93–5.98, p < 0.001). The additions of CK-MB to ACEF score, Mehran score A and Mehran score B resulted in increases in C-statistics, which ranged from 0.680 to 0.733 (p = 0.046), 0.694 to 0.727 (p = 0.091), 0.704 to 0.734 (p = 0.102), respectively. Internal validation also showed increases in C-statistics, and external validation performed well in discrimination and calibration. Conclusions Preprocedural peak CK-MB was a predictor of CI-AKI among MI patients.
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Affiliation(s)
- Wen Wei
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Lingyu Zhang
- Department of Cardiology, Maoming People's Hospital, Maoming, 525000, China
| | - Yunhan Zhang
- Kunming Medical University, Kunming, 650500, China
| | - Ronghui Tang
- Department of Ultrasound Imaging, Yunnan Fuwai Cardiovascular Hospital, Kunming, 650500, China
| | - Miao Zhao
- Department of Ultrasound Imaging, Yunnan Fuwai Cardiovascular Hospital, Kunming, 650500, China
| | - Zhidong Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Danyuan Xu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yibo He
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Bo Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Haozhang Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Qiang Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Mengfei Lin
- Department of Cardiology, Maoming People's Hospital, Maoming, 525000, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510100, China
| | - Kaihong Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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8
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Öztürk R, İnan D, Güngör B. Systemic Immune-Inflammation Index Is a Predictor of Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction. Angiology 2021; 73:125-131. [PMID: 34231412 DOI: 10.1177/00033197211029094] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We evaluated the predictive value of admission systemic immune-inflammation index (SII) for the risk of contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and SII (platelet × NLR) levels were calculated in 1621 consecutive patients with STEMI. The relationship of these parameters with CIN development within 72 hours of pPCI was analyzed. Of the study population, 343 (21.1%) cases developed CIN. The frequency of CIN was 11.1% in the first SII quartile, 11.6% in the second SII quartile, 26.8% in the third SII quartile, and 35% in the fourth SII quartile, which differed significantly between groups (P < .01). Age, baseline glomerular filtration rate, contrast media volume, hypertension, C-reactive protein levels, and the quartiles of SII were independent predictors of CIN. Patients in the third SII quartile versus first SII quartile (OR: 2.906, 95% CI, 1.903-4.437; P < .001), and fourth SII quartile versus first SII quartile (OR: 4.168, 95% CI, 2.754-6.313; P < .001) had a significantly higher risk for CIN in the multivariable model. The SII may be a promising inflammatory parameter to predict CIN after pPCI.
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Affiliation(s)
- Recep Öztürk
- Department of Cardiology, University of Health Sciences, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - Duygu İnan
- Department of Cardiology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Barış Güngör
- Department of Cardiology, University of Health Sciences, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
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9
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Mandurino-Mirizzi A, Kajana V, Cornara S, Somaschini A, Demarchi A, Galazzi M, Crimi G, Ferlini M, Camporotondo R, Gnecchi M, Ferrario M, Oltrona-Visconti L, De Ferrari GM. Elevated serum uric acid is a predictor of contrast associated acute kidney injury in patient with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Nutr Metab Cardiovasc Dis 2021; 31:2140-2143. [PMID: 34039505 DOI: 10.1016/j.numecd.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Contrast associated-acute kidney injury (CA-AKI) has been associated with adverse outcomes after ST-segment elevation myocardial infarction (STEMI). However, early markers of CA-AKI are still needed to improve risk stratification. We investigated the association between elevated serum uric acid (eSUA) and CA-AKI in patients with STEMI treated with primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS Serum creatinine (Scr) was measured at admission and 24, 48 and 72 h after pPCI. CA-AKI was defined as an increase of 25% (CA-AKI 25%) or 0.5 mg/dl (CA-AKI 0.5) of Scr level above the baseline after 48 h following contrast administration. Multivariable analyses to investigate CA-AKI predictors were performed by binary logistic regression and multivariable backward logistic regression model. In the 3023 patients considered, CA-AKI was more frequent among patients with eSUA as compared with patients with normal SUA levels, considering both CA-AKI definitions (CA-AKI25%: 20.8% vs 16.2%, p < 0.012; CA-AKI 0.5: 10.1% vs 5.8%, p < 0.001). The association between eSUA and CA-AKI was confirmed at multivariable analyses (CA-AKI 25%: odd ratio 1.32, 95% CI 1.03-1.69, p = 0.027; CA-AKI 0.5: odd ratio 1.76, 95% CI 1.11-2.79, p = 0.016). CONCLUSION Elevated serum uric acid is associated with CA-AKI after reperfusion in patients with STEMI treated with pPCI.
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Affiliation(s)
- Alessandro Mandurino-Mirizzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Vilma Kajana
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Cornara
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alberto Somaschini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Demarchi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Galazzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardio-Thoraco-Vascular Department, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rita Camporotondo
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimiliano Gnecchi
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Gaetano M De Ferrari
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardio-Thoraco-Vascular Department, Ospedale Policlinico San Martino IRCCS, Genova, Italy
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10
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Long-Term Follow-Up of Contrast-Induced Acute Kidney Injury: A Study from a Developing Country. Int J Vasc Med 2021; 2020:8864056. [PMID: 33414964 PMCID: PMC7769673 DOI: 10.1155/2020/8864056] [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: 07/24/2020] [Revised: 12/04/2020] [Accepted: 12/13/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Contrast-induced acute kidney injury (CI-AKI) is a worldwide known complication related to the use of contrast media with either imaging or angiography; it carries its own complications and effect on both morbidity and mortality; early identification of patients at risk and addressing modifiable risk factors may help reducing risk for this disease and its complications. Methods This was a prospective observational study, where all patients admitted for cardiac catheterization between June 2015 and January 2016 were evaluated for CI-AKI. There were two study groups: contrast-induced acute kidney injury (CI-AKI) group, and noncontrast-induced acute kidney injury (non-CI-AKI) group. Results Patients (n = 202) were included and followed up for 4 years. Death and development of chronic kidney disease (CKD) need for another revascularization were the end points. The incidence of CI-AKI was 14.8%.In univariate analysis, age (P = 0.016) and serum albumin at admission (P = 0.001) were statistically significant predictors of overall death. Age (P = 0.002), HTN (P = 0.002), DM (P = 0.02), and the use of diuretics (P = 0.001) had a statistically significant impact on eGFR. The rate of recatheterization was not statistically significant between the two groups (61 (35.5%) for the non-CI-AKI vs. 12 (40%) for the other group; P = 0.63). Some inflammatory markers (NGAL P = 0.06, IL-19 P = 0.08) and serum albumin at admission P = 0.07 had a trend toward a statistically significant impact on recatheterization. Death (P = 0.66) and need for recatheterization (P = 0.63) were not statistically different between the 2 groups, while the rate of eGFR decline in for the CI-AKI was significant (P = 0.004). Conclusion CI-AKI is a common complication post percutaneous catheterization (PCI), which may increase the risk for CKD, but not death or the need for recatheterization. Preventive measures must be taken early to decrease the morbidity.
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11
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Kucukosmanoglu M, İçen YK, Sumbul HE, Koca H, Koc M. Residual SYNTAX Score Is Associated With Contrast-Induced Nephropathy in Patients With Non-ST Segment Elevation Myocardial Infarction With Preserved LVEF. Angiology 2020; 71:799-803. [PMID: 32462903 DOI: 10.1177/0003319720928673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study is to investigate the relation between residual SYNTAX score (rSS) and contrast-induced nephropathy (CIN) development in patients with non-ST segment elevation myocardial infarction (NSTEMI) with normal or near-to-normal left ventricular ejection fraction (LVEF) who underwent percutaneous coronary intervention (PCI). A total of 306 patients who underwent PCI with NSTEMI were included in our study. SYNTAX scores were calculated for the periods before and after PCI. Patients were divided into 2 groups as developed CIN following PCI (CIN +) and patients did not (CIN -). Fifty-four (17.6%) of patients who were included in the study developed CIN. Age (P = .001) and rSS (P = .002) were significantly higher and LVEF was lower (P = .034) in the CIN (+) group. Age (P = .031, odds ratio [OR]: 1.031, 95% CI, 1.003-1.059) and rSS (P = .04, OR: 1.036, 95% CI, 1.002-1.071) were independent predictors for CIN. In receiver operating characteristic analyses, when the cutoff value of rSS was taken as 3.5, it determined CIN with 79% sensitivity and 65% specificity. Contrast-induced nephropathy may develop more frequently in patients with increased rSS value. The rSS may be useful to follow-up these patients for CIN development.
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Affiliation(s)
- Mehmet Kucukosmanoglu
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Yahya Kemal İçen
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Hasan Koca
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Mevlut Koc
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
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12
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Yu Q, Zhu JJ, Liu WX. Effect of continuous use of metformin on kidney function in diabetes patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. BMC Cardiovasc Disord 2020; 20:187. [PMID: 32316910 PMCID: PMC7175536 DOI: 10.1186/s12872-020-01474-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/12/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Diabetes patients presenting with ST-segment elevation myocardial infarction (STEMI) scheduled for primary percutaneous coronary intervention (PCI) have an increased risk of contrast induced-acute kidney injury (CI-AKI). The effects of continuous use of metformin on kidney function are still controversial in patients submitted to primary PCI. This study aimed to assess continuous metformin therapy on kidney function in diabetic patients undergoing coronary intervention. METHODS Two hundred eighty-four patients with metformin-treated diabetes, who underwent coronary intervention within 24 h for STEMI, were enrolled in the retrospective study. All the patients had estimated glomerular filtration rate (eGFR) of > 30 mL/min/1.73 m2. According to the physicians' decisions after admission, 119 patients continued metformin treatment after primary PCI, while 165 patients discontinued it > 48 h after the procedure. Serum creatinine was collected at admission and within 48 h post primary PCI to evaluate the incidence of CI-AKI. We performed a multiple logistic regression analysis to examine the determinants of CI-AKI. RESULTS No statistical difference in CI-AKI incidence between the continuous and the discontinuous metformin group (12.6%vs10.3%, p = 0.545). Multivariable logistic regression analysis indicated eGFR ≤60 ml/min/1.73 m2[p = 0.025, OR: 3.131; 95% CI (1.156-8.482)] and contrast volume [p = 0.002, OR: 1.010; 95% CI (1.004-1.016)] were predictive factors of CI-AKI. Metformin therapy was irrelevant to CI-AKI [p = 0.365, OR: 0.698; 95% CI (0.320-1.521)]. No case of lactic acidosis was found in this study. Besides, the study supported discontinuation of metformin was not beneficial for patients' blood glucose control after admission. CONCLUSIONS The study indicated that the metformin continuation after primary PCI for STEMI in diabetic patients with eGFR > 30 ml/min / 1.73 m2 did not increase the risk of CI-AKI.
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Affiliation(s)
- Qi Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029 China
| | - Jia-Jia Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029 China
| | - Wen-Xian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029 China
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