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Chen Y, Ai D, Yu Y, Fan J, Yu W, Xiao D, Lin Y, Yang J. Cardio-respiratory motion compensation for coronary roadmapping in fluoroscopic imaging. Med Phys 2024. [PMID: 38865713 DOI: 10.1002/mp.17241] [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: 08/16/2023] [Accepted: 03/01/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Inferring the shape and position of coronary artery poses challenges when using fluoroscopic image guidance during percutaneous coronary intervention (PCI) procedure. Although angiography enables coronary artery visualization, the use of injected contrast agent raises concerns about radiation exposure and the risk of contrast-induced nephropathy. To address these issues, dynamic coronary roadmapping overlaid on fluoroscopic images can provide coronary visual feedback without contrast injection. PURPOSE This paper proposes a novel cardio-respiratory motion compensation method that utilizes cardiac state synchronization and catheter motion estimation to achieve coronary roadmapping in fluoroscopic images. METHODS For more accurate cardiac state synchronization, video frame interpolation is applied to increase the frame rate of the original limited angiographic images, resulting in higher framerate and more adequate roadmaps. The proposed method also incorporates a multi-length cross-correlation based adaptive electrocardiogram (ECG) matching to address irregular cardiac motion situation. Furthermore, a shape-constrained path searching method is proposed to extract catheter structure from both fluoroscopic and angiographic image. Then catheter motion is estimated using a cascaded matching approach with an outlier removal strategy, leading to a final corrected roadmap. RESULTS Evaluation of the proposed method on clinical x-ray images demonstrates its effectiveness, achieving a 92.8% F1 score for catheter extraction on 589 fluoroscopic and angiographic images. Additionally, the method achieves a 5.6-pixel distance error of the coronary roadmap on 164 intraoperative fluoroscopic images. CONCLUSIONS Overall, the proposed method achieves accurate coronary roadmapping in fluoroscopic images and shows potential to overlay accurate coronary roadmap on fluoroscopic image in assisting PCI.
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Affiliation(s)
- Ying Chen
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of Technology, Beijing, China
| | - Danni Ai
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of Technology, Beijing, China
| | - Yang Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingfan Fan
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of Technology, Beijing, China
| | - Wenyuan Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Deqiang Xiao
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of Technology, Beijing, China
| | - Yucong Lin
- Institute of Engineering Medicine, Beijing Institute of Technology, Beijing, China
| | - Jian Yang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of Technology, Beijing, China
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Hennessey B, Danenberg H, De Vroey F, Kirtane AJ, Parikh M, Karmpaliotis D, Messenger JC, Strobel A, Curcio A, van Mourik MS, Eshuis P, Escaned J. Dynamic Coronary Roadmap versus standard angiography for percutaneous coronary intervention: the randomised, multicentre DCR4Contrast trial. EUROINTERVENTION 2024; 20:e198-e206. [PMID: 38343370 PMCID: PMC10851082 DOI: 10.4244/eij-d-23-00460] [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: 06/08/2023] [Accepted: 10/24/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Decreasing the amount of iodinated contrast is an important safety aspect of percutaneous coronary interventions (PCI), particularly in patients with a high risk of contrast-induced acute kidney injury (CI-AKI). Dynamic Coronary Roadmap (DCR) is a PCI navigation support tool projecting a motion-compensated virtual coronary roadmap overlay on fluoroscopy, potentially limiting the need for contrast during PCI. AIMS This study investigates the contrast-sparing potential of DCR in PCI, compared to standard angiographic guidance. METHODS The Dynamic Coronary Roadmap for Contrast Reduction (DCR4Contrast) trial is a multicentre, international, prospective, unblinded, stratified 1:1 randomised controlled trial. Patients were randomised to either DCR-guided PCI or to conventional angiography-guided PCI. The primary endpoint was the total volume of iodinated contrast administered, and the secondary endpoint was the number of cineangiography runs during PCI. RESULTS The study population included 356 randomised patients (179 in DCR and 177 in control groups, respectively). There were no differences in patient demographics, angiographic characteristics or estimated glomerular filtration rate (eGFR) between the two groups. The total contrast volume used during PCI was significantly lower with DCR guidance compared with conventional angiographic guidance (64.6±44.4 ml vs 90.8±55.4 ml, respectively; p<0.001). The total number of cineangiography runs was also significantly reduced in the DCR group (8.7±4.7 vs 11.7±7.6 in the control group; p<0.001). CONCLUSIONS Compared to conventional angiography-guided PCI, DCR guidance was associated with a significant reduction in both contrast volume and the number of cineangiography runs during PCI. (ClinicalTrials.gov: NCT04085614).
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Affiliation(s)
- Breda Hennessey
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
- Department of Cardiology, Blackrock Clinic, Dublin, Ireland
| | - Haim Danenberg
- Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Interventional Cardiology Division, Wolfson Medical Center, Holon, Israel
| | - Frédéric De Vroey
- Department of Cardiology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Ajay J Kirtane
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA and the Cardiovascular Research Foundation, New York, NY, USA
| | - Manish Parikh
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA and the Cardiovascular Research Foundation, New York, NY, USA
- Division of Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Dimitrios Karmpaliotis
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA and the Cardiovascular Research Foundation, New York, NY, USA
- Division of Cardiology, Morristown Medical Center, Morristown, NJ, USA
| | - John C Messenger
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Aaron Strobel
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, Baptist Health Heart Institute, Little Rock, AK, USA
| | - Alejandro Curcio
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | | | | | - Javier Escaned
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
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Hennessey B, Messenger JC, Kirtane AJ, Parikh M, Danenberg H, De Vroey F, Curcio A, Eshuis P, Escaned J. Rationale and design of the Dynamic Coronary Roadmap for Contrast Reduction (DCR4Contrast) in PCI randomized controlled trial. Am Heart J 2023; 263:151-158. [PMID: 37040861 DOI: 10.1016/j.ahj.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The clinical and anatomic complexity of patients undergoing percutaneous coronary interventions (PCI) has increased significantly over the past 2 decades. Contrast induced nephropathy (CIN) significantly impacts prognosis after PCI, therefore minimizing the risk of CIN is important in improving clinical outcomes. Dynamic Coronary Roadmap (DCR) is a PCI navigation support tool which may decrease CIN by projecting a motion-compensated virtual coronary roadmap overlay on fluoroscopy, potentially reducing iodinated contrast volume during PCI. STUDY DESIGN AND OBJECTIVES The Dynamic Coronary Roadmap for Contrast Reduction trial (DCR4Contrast) is a multi-center, prospective, unblinded, stratified 1:1 randomized controlled trial investigating if DCR use reduces the total contrast volume administered during PCI compared to PCI performed without DCR guidance. DCR4Contrast aims to recruit 394 patients undergoing PCI. The primary end point is the total undiluted iodinated contrast volume administered during the PCI, performed with or without DCR. As of November 14, 2022, 346 subjects have been enrolled. CONCLUSIONS The DCR4Contrast study will investigate the potential contrast-sparing effect of the DCR navigation support tool in patients undergoing PCI. By reducing iodinated contrast administration, DCR has the potential to contribute to reduced risk of CIN and thus increase PCI safety. CLINICAL TRIAL REGISTRATION URL https://clinicaltrials.gov/ct2/show/NCT04085614.
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Affiliation(s)
- Breda Hennessey
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - John C Messenger
- Division of Cardiology, Department of Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO
| | - Ajay J Kirtane
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Manish Parikh
- Division of Cardiology, New York-Presbyterian/Brooklyn Methodist Hospital, New York, NY
| | - Haim Danenberg
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Interventional Cardiology Division, Wolfson Medical Centre Holon, Holon, Israel
| | - Frédéric De Vroey
- Department of Cardiology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Alejandro Curcio
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain.
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Rognoni C, Segantin G, Scarsini R, Valgimigli M, Loizzi F, Costa F, Armeni P. Cost-effectiveness analysis of pressure-controlled intermittent coronary sinus occlusion in elective percutaneous coronary intervention. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1101-1111. [PMID: 37589294 DOI: 10.1080/14737167.2023.2249612] [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: 03/29/2023] [Revised: 07/17/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES Percutaneous coronary intervention (PCI) represents the standard treatment for ST-elevated myocardial infarction, nevertheless, mortality and heart failures are frequent. Pressure-controlled intermittent coronary sinus occlusion (PiCSO) might reduce infarct size showing better patients' outcomes. We evaluated the cost-effectiveness of PCI+PiCSO compared to PCI from the National Healthcare Service (NHS) perspective in Italy. METHODS A Markov model was developed to estimate life years (LYs), quality-adjusted life years (QALYs) and costs. A micro-costing analysis has been performed to inform the cost of PCI+PiCSO procedure. Sensitivity analyses were performed to test the robustness of the model results. RESULTS Considering a willingness-to-pay threshold of 50,000€/QALY for the ICUR and a cost for PCI+PiCSO procedure of 14,654€, the innovative strategy may be cost-effective compared to PCI alone from the Italian NHS perspective, showing an ICUR of 17,530€/QALY (ICER 14,631€/LY) over a lifetime horizon; the probabilistic sensitivity analysis showed that PCI+PiCSO is cost-effective in 78.8% of simulations.Considering the above mentioned willingness-to-pay threshold, PCI+PiCSO strategy would be cost-effective over a lifetime horizon considering a cost for PCI+PiCSO procedure lower than 28,160€. CONCLUSION PCI+PiCSO procedure may be considered a cost-effective technology that allows reducing cardiac events, while improving patients' life expectancy and quality of life.
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Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Gaia Segantin
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Roberto Scarsini
- Azienda Ospedaliera Universitaria di Verona, Dipartimento di Cardiologia, Verona, Italia
| | - Marco Valgimigli
- EOC - Ente Ospedaliero Cantonale - Ospedale Regionale di Lugano, Istituto Cardiocentro Ticino, Lugano, Svizzera
| | - Francesco Loizzi
- EOC - Ente Ospedaliero Cantonale - Ospedale Regionale di Lugano, Istituto Cardiocentro Ticino, Lugano, Svizzera
| | - Francesco Costa
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Patrizio Armeni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy
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López-Mínguez JR, Martín de Francisco AL, Soler MJ, Hernández F, Moreno R, Pinar E, Sampedro A, Mareque M, Oyagüez I. Cost-effectiveness analysis of dyevert™ Power XT in patients with chronic kidney disease undergoing percutaneous coronary intervention procedures in Spain. Catheter Cardiovasc Interv 2023. [PMID: 37300893 DOI: 10.1002/ccd.30744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the efficiency of Dyevert™ Power XT compared to the standard clinical practice when used for percutaneous coronary interventions (PCI). METHODS A Markov model was developed to estimate, over 3-month cycles and a lifetime time horizon, the cumulative costs and health outcomes (life years gained [LYG] and quality-adjusted life years [QALY]) in a hypothetical cohort of 1,000 patients with chronic kidney disease (CKD) 3b-4 and an average age of 72 years. The incidence of contrast-induced acute kidney injury for these patients is 18.89% in routine practice and 7.78% with Dyevert. QALYs were estimated by applying utilities by health state. Transitions between states and utilities were obtained from the literature. Overall all-cause and state-specific mortality were considered. The total cost (€2,022) estimated with the National Health System perspective included cost of the procedure and of CKD management. The parameters were validated by a panel of experts. A discount rate (3% per year) was applied to costs and outcomes. RESULTS The use of Dyevert yielded more health benefits (34.60 LYG and 5.69 QALYs) compared to the current standard practice (33.11 LYG and 5.38 QALYs). Lifetime cost accumulated at the end of the simulation resulted €30,211/patient with Dyevert and €33,895/patient with current standard clinical practice. CONCLUSIONS The use of Dyevert™ Power XT resulted dominant option, due to its higher effectiveness and lower cost as compared to standard clinical practice and, therefore, a preferred option in patients with CKD stages 3b-4 undergoing PCI in Spain.
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Affiliation(s)
- Jose R López-Mínguez
- Sección de Hemodinámica y Cardiología Intervencionista, Hospital Universitario de Badajoz, Badajoz, España
| | | | - M J Soler
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Felipe Hernández
- Unidad de Hemodinámica y Cardiología Intervencionista, Clínica Universidad de Navarra, Madrid, España
| | - Raul Moreno
- Unidad de Cardiología Intervencionista, Hospital Universitario La Paz, Madrid, España
| | - Eduardo Pinar
- Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - M Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| | - I Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
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Scridon A, Somkereki C, Nicoară TR, Oprica M, Demian L. Neutrophil gelatinase-associated lipocalin monitoring reveals persistent subclinical kidney injury following intraarterial administration of iodinated contrast agents. Sci Rep 2022; 12:19464. [PMID: 36376542 PMCID: PMC9663446 DOI: 10.1038/s41598-022-24169-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Clinically overt contrast-induced nephropathy (CIN) is one of the most feared complications in patients exposed to iodinated contrast media and has been extensively studied over the years. Meanwhile, the incidence and evolution of subclinical contrast-induced kidney injury remain elusive. With the continuous increase in the number of patients that are repeatedly exposed to contrast media, elucidating these issues is of critical importance. Accordingly, we aimed to evaluate the incidence and the evolution of clinical and subclinical kidney injury in patients exposed to contrast media. A total of 178 patients who underwent elective percutaneous angioplasty procedures were evaluated prospectively. Serum creatinine and neutrophil gelatinase-associated lipocalin (NGAL) levels were evaluated pre-procedurally, 48 h and 1 month after administration of contrast media. The evolution of creatinine and NGAL levels was analyzed at the three time points, and the potential predictors of contrast-induced clinical and subclinical renal injury were evaluated. Clinically overt CIN occurred in 10 (5.6%) patients. Baseline serum creatinine and the volume of contrast media were the only independent predictors of CIN and in all 10 patients creatinine levels returned to baseline by 1 month (p = 0.32). Subclinical contrast-induced kidney injury was much more common, affecting 32 (17.9%) patients, was only predicted by the baseline serum creatinine, and persisted in 53.1% of patients after 1 month. This study showed that whereas clinically overt CIN is rather rare and regressive, subclinical contrast-induced kidney injury is considerably more frequent, affecting almost 18% of patients that receive intraarterial contrast media. More importantly, subclinical kidney injury persisted after 1 month in more than 50% of the initially affected patients, who may thus be at increased risk for further renal impairment, particularly if exposed to nephrotoxic agents or repeated administration of contrast media.
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Affiliation(s)
- Alina Scridon
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Târgu Mureș, Romania ,Physiology Department, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, 38, Gheorghe Marinescu Street, 540139 Târgu Mureș, Romania
| | - Cristina Somkereki
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Târgu Mureș, Romania ,grid.514016.7Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureș, Târgu Mureș, Romania
| | - Tunde Renata Nicoară
- grid.514016.7Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureș, Târgu Mureș, Romania
| | - Mădălina Oprica
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Târgu Mureș, Romania
| | - Liliana Demian
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Târgu Mureș, Romania
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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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Hou J, Cao G, Liu J, Cai L, Zhao L, Li X. Risk factors for acute renal injury caused by contrast media after percutaneous coronary intervention and coronary angiography: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28897. [PMID: 35363209 PMCID: PMC9282126 DOI: 10.1097/md.0000000000028897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Contrast-induced acute kidney injury (CI-AKI) caused by contrast medium is one of the common complications of percutaneous coronary intervention (PCI)/coronary angiography (CAG). Early identification of the risk factors of CI-AKI in patients with PCI/CAG and help clinical staff to prevent and intervene as soon as possible is very important to improve the clinical outcome of patients. Although domestic and foreign scholars have studied and summarized the risk factors of CI-AKI in PCI/CAG, the conclusions are not the same. Therefore, in this study, meta-analysis was used to summarize the risk factors of CI-AKI in patients with PCI/CAG, and to explore the characteristics of high-risk groups of CI-AKI, to provide reference for early identification and prevention of clinical doctors and nurses. METHODS We will search related literature of PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database. Eligible studies will be screened based on inclusion criteria, and data extraction, risk of bias assessment, publication bias assessment, subgroup analysis, and quality assessment will be performed. Review Manager version 5.3 software will be used for data analysis. Each process is independently conducted by 2 researchers, and if there is any objection, it will be submitted to the third researcher for resolution. RESULTS We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. CONCLUSIONS The results of this analysis can be used to generate a risk prediction model and provide an intervention strategy for the occurrence of CI-AKI in PCI/CAG.
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Affiliation(s)
- Junhuan Hou
- Department of Radiology, Army Medical Center of PLA, Chongqing, China
| | - Guanghua Cao
- Department of Radiology, Army Medical Center of PLA, Chongqing, China
| | - Junling Liu
- Department of Radiology, Army Medical Center of PLA, Chongqing, China
| | - Li Cai
- Department of Radiology, Army Medical Center of PLA, Chongqing, China
| | - Li Zhao
- Department of Radiology, Army Medical Center of PLA, Chongqing, China
| | - Xue Li
- Department of Radiology, Army Medical Center of PLA, Chongqing, China
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Abdalla MA, Ahmed KO, Yousef BA. Incidence and Risk Factors of Contrast-Induced Acute Kidney Injury in Sudanese Patients Undergoing Coronary Angiography: A Descriptive Prospective Study. Cureus 2022; 14:e21876. [PMID: 35273847 PMCID: PMC8901158 DOI: 10.7759/cureus.21876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Contrast-induced acute kidney injury (CI-AKI) has been reported to be the third most common cause of hospital-acquired acute kidney injury (AKI) and is associated with significant morbidity and mortality. Objectives: This study aimed to assess the incidence and risk factors of CI-AKI in Sudanese patients undergoing coronary angiography. Methods: The study was a descriptive, prospective, hospital-based study conducted at Alshaab Hospital between January and April 2019. A total of 163 patients undergoing coronary angiography were enrolled, and a checklist was used to collect data. Chi-square and regression analyses were performed to identify the risk factors of CI‑AKI. CI‑AKI was defined as a rise in serum creatinine ≥25% above baseline within three days after percutaneous coronary angiography (PCA). Results: CI‑AKI incidence in patients undergoing coronary angiography was 31.9% (52/163). Among independent variables, diabetes mellitus, the type of coronary angiography, and the volume of contrast medium were statistically significantly (p-value ˂ 0.05) associated with CI-AKI development. Logistic analysis showed that diabetes (odds ratio (OR): 15.2; 95% CI: 6.771-33.974; p = 0.001), percutaneous coronary intervention (PCI) (OR: 2.4; 95% CI: 1.168-4.901; p = 0.017), and the volume of contrast medium (OR 2.1; 95% CI: 1.440-3.054; p = 0.001) were independent predictors correlated to CI‑AKI development. Conclusion: The incidence of CI-AKI is 31.9%, and diabetes mellitus, PCI, and high volume of contrast medium are associated with a higher risk of CI-AKI in patients undergoing coronary angiography.
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10
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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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11
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Yang JQ, Guo XS, Ran P, Hu XM, Tan N. The relationship between pre-procedural elevated arterial lactate and contrast-induced nephropathy following primary percutaneous coronary intervention. J Thorac Dis 2021; 13:5467-5476. [PMID: 34659813 PMCID: PMC8482345 DOI: 10.21037/jtd-21-1153] [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: 07/01/2021] [Accepted: 08/05/2021] [Indexed: 01/01/2023]
Abstract
Background Risk stratification has been one of the main steps in preventing contrast-induced nephropathy (CIN), which is a common complication after percutaneous coronary intervention (PCI). Elevated arterial lactate is a biomarker indicating severe disease condition and post-intervention complications. The relationship between lactate and CIN has not been established. This study is performed to investigate the relationship between elevated arterial lactate level and contrast-induced nephropathy (CIN). Methods Patients diagnosed with ST-segment elevated myocardial infarction (STEMI) were prospectively enrolled, with lactate measured within 0.5–1 hours before primary percutaneous coronary intervention (PCI). Patients with cardiopulmonary resuscitation, any forms of severe anaerobic condition, or end-stage renal disease undergoing dialysis were excluded. CIN was defined as an increase in serum creatinine ≥0.5 mg/dL or 25% within 72 hours after PCI. The Mehran Risk Score (MRS) is widely regarded as a classic risk model for CIN and the risk factors of MRS were applied in our multivariate regression analysis. Results Of the 227 enrolled patients, 47 (20.7%) developed CIN according to the definition. The mean lactate level was higher in the CIN group than in the non-CIN group (2.68±2.27 vs. 1.74±1.94, P<0.001). The arterial lactate level ≥2.0 mmol/L had 57.5% sensitivity and 75.6% specificity in predicting CIN. The performance of the lactate level in discriminating CIN was similar to that of the MRS (AUClac =0.707 vs. AUCMRS =0.697, P=0.86). After adjusting for other risk factors, lactate ≥2.0 mmol/L still significantly predicted CIN (odds ratio =3.77, 95% CI, 1.77–7.99, P=0.001). Conclusions An arterial lactate level of ≥2.0 mmol/L is associated with CIN in STEMI patients after primary PCI.
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Affiliation(s)
- Jun-Qing Yang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-Sheng Guo
- Department of Intensive Care Unit, Zhuhai Golden Bay Center Hospital, Guangdong Provincial People's Hospital Zhuhai Hospital, Zhuhai, China
| | - Peng Ran
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiang-Ming Hu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ning Tan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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12
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Greene T, Hasenstein T, Choi ET, Meyr AJ. Level of Agreement Between Systematic Doppler Examination of the Lower Extremity and Diagnostic Angiography in the Setting of Peripheral Arterial Disease. J Am Podiatr Med Assoc 2021; 111:466696. [PMID: 34144576 DOI: 10.7547/18-140] [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: 02/03/2023]
Abstract
BACKGROUND The objective of this investigation was to determine the level of agreement between a systematic clinical Doppler examination of the foot and ankle and diagnostic peripheral angiography. METHODS The described Doppler examination technique attempted to determine the patency, quality, and direction of the flow through the dorsalis pedis artery, posterior tibial artery, terminal branches of the peroneal artery, and vascular arch of the foot. These results were then compared with angiographic distal run-off images as interpreted by a blinded vascular surgeon. RESULTS Levels of agreement with respect to artery patency/quality ranged from 64.0% to 84.0%. Sensitivity ranged from 53.8% to 84.2%, and specificity ranged from 64.7% to 91.7%. Agreement with respect to arterial flow direction ranged from 73.3% to 90.5%. CONCLUSIONS We interpret these results to indicate that this comprehensive physical examination technique of the arterial flow to the foot and ankle with a Doppler device might serve as a reasonable initial surrogate to diagnostic angiography in some patients with peripheral arterial disease.
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13
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Katsogridakis E, Lea T, Yap T, Batchelder A, Saha P, Diamantopoulos A, Saratzis N, Davies R, Zayed H, Bown MJ, Saratzis A. Acute kidney injury following endovascular intervention for peripheral artery disease. Br J Surg 2021; 108:152-159. [PMID: 33711140 DOI: 10.1093/bjs/znaa057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/21/2020] [Accepted: 09/27/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The incidence of, and risk factors for, acute kidney injury (AKI) after endovascular intervention for peripheral artery disease (PAD) remain unknown. The aim of this study was to assess the proportion of patients who develop AKI and explore the risk factors. METHODS Prospectively collected data on patients undergoing femoropopliteal endovascular intervention for symptomatic PAD across three vascular centres were analysed. The proportion of patients developing AKI (according to the Kidney Disease Improving Global Outcomes definition) within 48 h, and the proportion developing the composite Major Adverse Kidney Events (MAKE) endpoints (death, dialysis, drop in estimated glomerular filtration rate at least 25 per cent) at 30 days (MAKE30) and remains 90 days (MAKE90) were calculated. Multivariable regression analysis was used to assess predictors of AKI, and the association between AKI and death. RESULTS Some 2041 patients were included in the analysis. AKI developed in 239 patients (11.7 per cent), with 47 (2.3 per cent) requiring dialysis within 30 days, and 18 (0.9 per cent) requiring ongoing dialysis. The MAKE30 and MAKE90 composite endpoints were reached in 358 (17.5 per cent) and 449 (22.0 per cent) patients respectively. Risk factors for AKI were age, sex, congestive heart failure, chronic limb-threatening ischaemia, emergency procedure, and pre-existing chronic kidney disease. AKI, dementia, congestive heart failure, and major amputation were risk factors for medium-term mortality. CONCLUSION AKI is a common complication after intervention for PAD and is associated with medium-term mortality.
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Affiliation(s)
- E Katsogridakis
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - T Lea
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - T Yap
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Batchelder
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - P Saha
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Diamantopoulos
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - N Saratzis
- Department of Vascular Surgery, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - R Davies
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - H Zayed
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - M J Bown
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - A Saratzis
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.,Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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14
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Lo MY, Chen MS, Jen HM, Chen CC, Shen TY. A rare complication of cerebral venous thrombosis during simple percutaneous coronary intervention: A case report. Medicine (Baltimore) 2021; 100:e24008. [PMID: 33530197 PMCID: PMC7850649 DOI: 10.1097/md.0000000000024008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Cerebrovascular accidents (CVAs) after percutaneous coronary intervention (PCI), although rare, are associated with high in-hospital morbidity and mortality rates. Cerebral venous thrombosis (CVT) is an uncommon cause of CVAs compared with arterial disease but is associated with favorable outcomes in most cases. We present a rare case of CVT following a simple PCI procedure with stent implantation, which has not been previously reported in the literature. PATIENT CONCERNS A 78-year-old woman with hypertension, hyperlipidemia, and coronary artery disease received simple PCI with stent implantation. After PCI, she developed a throbbing headache with nausea and vomiting, with her blood pressure increasing to 190/100 mmHg. Drowsiness, disorientation, and neck stiffness were noted. Neurological complication due to the PCI procedure was highly suspected. DIAGNOSIS Noncontrast brain computed tomography was performed along with emergency neurological consultation, and the patient was diagnosed as having acute CVT. INTERVENTIONS The patient was treated with anti-intracranial pressure therapy and anticoagulation therapy through low-molecular-weight heparin and was subsequently treated with warfarin. OUTCOMES After treatment, the patient's symptoms and signs gradually subsided, and her clinical condition improved. She was discharged with full recovery thereafter. LESSONS A case of acute CVT, a rare, and atypical manifestation of venous thromboembolism and CVA, complicated simple PCI with stent implantation. During PCI, identifying patients with a high risk of a CVA is critical, and special care should be taken to prevent this devastating complication.
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Affiliation(s)
- Ming Yuan Lo
- Cardiovascular Center, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ming-Shiu Chen
- Cardiology Department, Chang Bing Show Chwan Memorial Hospital, Lukang Town, Changhua County, Taiwan
| | - Hsuan-Ming Jen
- Cardiovascular Center, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chien-Cheng Chen
- Cardiovascular Center, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Thau-Yun Shen
- Cardiovascular Center, Show Chwan Memorial Hospital, Changhua, Taiwan
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15
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Conrotto F, D'Ascenzo F, Piroli F, Franzé A, de Luca L, Quadri G, Ryan N, Escaned J, Bo M, De Ferrari GM. Percutaneous coronary intervention of unprotected left main and bifurcation in octogenarians: Subanalysis from RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life). Catheter Cardiovasc Interv 2020; 97:755-763. [PMID: 32478451 DOI: 10.1002/ccd.29048] [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: 03/13/2020] [Accepted: 05/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Outcomes of complex percutaneous coronary interventions (PCIs) in older patients are still debated. The aim of the study was to evaluate clinical outcomes of Octogenarian patients treated with ultrathinstents on left main or on coronary bifurcations, compared with younger patients. METHODS All consecutive patients presenting a critical lesion of an unprotected left main (ULM) or a bifurcation and treated with very thin stents were included in the RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry and divided into octogenarians group (OG, 551 patients) and nonoctogenarians (NOGs, 2,453 patients). Major adverse cardiovascular event (MACE), a composite end point of all-cause death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST), was the primary endpoint, while MACE components, cardiovascular (CV) death, and target vessel revascularization (TVR) were the secondary ones. RESULTS Indication for PCI was acute coronary syndrome in 64.7% of the OG versus 53.1% of the NOG. Severe calcifications and a diffuse disease were significantly more in OG. After a follow-up of 15.2 ± 10.3 months, MACEs were higher in the OG than in the NOG patients (OG 19.1% vs. NOG 11.2%, p < .001), along with MI (OG 6% vs. NOG 3.4%, p = .002) and all-cause death (OG 14% vs. NOG 4.3%, p < .001). In contrast, no significant difference was detected in CV-death (OG 5.1% vs. NOG 4%, p = .871), TVR/TLR, or ST. At multivariate analysis, age was not an independent predictor of MACE (OR 1.02 CI 95% 0.76-1.38), while it was for all-cause death, along with diabetes, GFR < 60 ml/min, and ULM disease. DISCUSSION Midterm outcomes of complex PCI in OG are similar to those of younger patients. However, due to the higher non-CV death rate, accurate patient selection is mandatory.
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Affiliation(s)
- Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Alfonso Franzé
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Leonardo de Luca
- U.O.C. Cardiologia, Ospedale San Giovanni Evangelista, Rome, Italy
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Turin, Italy
| | - Nicola Ryan
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Mario Bo
- Division of Geriatrics, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
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16
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D'Amore C, Nuzzo S, Briguori C. Biomarkers of Contrast-Induced Nephropathy:: Which Ones are Clinically Important? Interv Cardiol Clin 2020; 9:335-344. [PMID: 32471674 DOI: 10.1016/j.iccl.2020.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is a common complication after intravascular injection of iodinated contrast media, and it is associated with a prolonged in-hospital stay and unfavorable outcome. CI-AKI occurs in 5% to 20% among hospitalized patients. Its diagnosis relies on the increase in serum creatinine levels, which is a late biomarker of kidney injury. Novel and early serum and urinary biomarkers have been identified to detect kidney damage before the expected serum creatinine increase.
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Affiliation(s)
- Carmen D'Amore
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Via Orazio 2, Naples 80121, Italy
| | - Silvia Nuzzo
- IRCCS, SDN, Via Gianturco 113, Naples 80143, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Via Orazio 2, Naples 80121, Italy.
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17
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Ma H, Smal I, Daemen J, Walsum TV. Dynamic coronary roadmapping via catheter tip tracking in X-ray fluoroscopy with deep learning based Bayesian filtering. Med Image Anal 2020; 61:101634. [DOI: 10.1016/j.media.2020.101634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/26/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
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18
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Çınar T, Karabağ Y, Ozan Tanık V, Çağdaş M, Rencüzoğulları İ, Öz A. The investigation of TIMI risk index for prediction of contrast-induced acute kidney injury in patients with ST elevation myocardial infarction. Acta Cardiol 2020; 75:77-84. [PMID: 30678606 DOI: 10.1080/00015385.2018.1551263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: Contrast-induced acute kidney injury (CI-AKI) is a well-known and life-threating complication in patients with ST-elevation myocardial infraction (STEMI) after primary percutaneous coronary intervention (PCI). Several studies demonstrated that the Thrombolysis in Myocardial Infarction (TIMI) Risk Index (TRI) is a useful risk model in predicting early mortality in patients with acute coronary syndrome. The objective of the present study is to evaluate the predictive value of admission TRI for the occurrence of CI-AKI in patients with STEMI treated with primary PCI.Methods: This retrospective study was consisted of a total of 660 consecutive STEMI patients who had undergone primary PCI from December 2015 to March 2017.The primary end-point was CI-AKI incidence after primary PCI during the in-hospital course.Results: The TRI of CI-AKI group was higher than the non-CI-AKI group (24.2 (19.3-32.2) vs. 17.5 (12.9-24.3), p < .001, respectively). In multivariable logistic regression analysis, TRI was found to be an independent predictors of CI-AKI (OR: 1.055, 95% CI: 1.027-1.083, p < .001). The discriminative power of TRI with regards to occurrence of CI-AKI was superior compared to its components.Conclusion: This study is the first to demonstrate that TRI can be used to predict the development of CI-AKI in patients with STEMI who undergo primary PCI. Health professionals might be able to use the TRI risk score to predict CI-AKI due to the simplicity and accessibility of this risk index.
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Affiliation(s)
- Tufan Çınar
- Department of Cardiology, Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Karabağ
- Department of Cardiology, Kafkas University, Kars, Turkey
| | - Veysel Ozan Tanık
- Department of Cardiology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Metin Çağdaş
- Department of Cardiology, Kafkas University, Kars, Turkey
| | | | - Ahmet Öz
- Department of Cardiology, Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
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19
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Zahler D, Rozenfeld KL, Merdler I, Peri Y, Shacham Y. Contrast Volume to Glomerular Filtration Ratio and Acute Kidney Injury among ST-Segment Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention. Cardiorenal Med 2019; 10:108-115. [PMID: 31801134 DOI: 10.1159/000504534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/01/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The ratio of contrast media volume to glomerular filtration rate (contrast/GFR) has been shown to correlate with the occurrence of contrast-induced acute kidney injury (CI-AKI) in unselected patient populations who underwent percutaneous coronary intervention (PCI). OBJECTIVE We evaluated the possible utilization of this marker and optimal cutoff among ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI. METHODS We retrospectively included 419 patients with STEMI treated with primary PCI. The occurrence of CI-AKI was defined by the KDIGO criteria as an increase in serum creatinine of ≥0.3 mg/dL within 48 h following PCI. A receiver-operator characteristic (ROC) curve was used to identify the optimal cutoff value of contrast/GFR ratio to predict CI-AKI. This value was then assessed using multivariable logistic regression. RESULTS The overall incidence of CI-AKI was 9%. The contrast/GFR ratio was significantly higher among patients with CI-AKI (2.7 ± 1.2 vs. 1.9 ± 0.9; p < 0.001). According to the ROC curve analysis, the optimal cutoff value of contrast/GFR ratio to predict AKI was measured as ≥2.13, with 70% sensitivity and 60% specificity (AUC 0.65, 95% CI 0.56-0.74; p = 0.002). In a multivariate logistic regression model, contrast/GFR ratio ≥2.13 was independently associated with CI-AKI (OR 2.46, 95% CI 1.09-5.57; p = 0.03). CONCLUSIONS Among STEMI patients undergoing primary PCI, contrast/GFR ratio ≥2.13 was independently associated with CI-AKI.
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Affiliation(s)
- David Zahler
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Keren-Lee Rozenfeld
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilan Merdler
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yogev Peri
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,
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20
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Lo K, Penalver J, Mostafavi Toroghi H, Jeon H, Habib N, Hung Pinto W, Ram P, Gupta S, Rangaswami J. Invasive Hemodynamic Predictors of Renal Outcomes after Percutaneous Coronary Interventions. Cardiorenal Med 2019; 9:382-390. [DOI: 10.1159/000500949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/10/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives: To determine the association of right heart invasive hemodynamic parameters with post-percutaneous coronary intervention (PCI) acute kidney injury (AKI). Background: AKI after PCI is associated with a high morbidity and mortality. Various mechanisms are implicated in AKI after PCI. However, the association between filling pressures and invasive hemodynamic measures of right heart function with post-PCI AKI has not been described. Methods: This is a retrospective single-center analysis of patients of who underwent simultaneous right heart catheterization (RHC) and left heart catheterization with PCI at the Einstein Medical Center, Philadelphia, between January 2010 and December 2016. We included patients who had hemodynamic parameters from the concomitant RHC as well as measurements of kidney function up to 1 month after the procedure. We excluded patients with ST elevation myocardial infarction, end-stage renal disease, cardiogenic shock, and PCI with a need for mechanical circulatory device support. Multivariate linear regression analysis was used to analyze the association between the various right ventricular hemodynamic parameters and eGFR within 1 week and 1 month after catheterization after adjusting for age, race, gender, diabetes and hypertension, contrast volume, cardiac index, and baseline eGFR. Results: Right atrial (RA) pressure was inversely associated with eGFR within 1 week (β = –1.66; 95% CI –3.06 to –0.25; p = 0.021) and 1 month after PCI (β = –2.14; 95% CI –4.08 to –0.20; p = 0.031). Conclusion: Elevated RA pressure is associated with a worsening kidney function after cardiac catheterization and PCI.
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Liu YH, Xue JH, Wu DX, Bei WJ, Wang K, Liu Y, Chen JY, Tan N. A novel simple experimental model for low-osmolar contrast-induced acute kidney injury using different definitions based on the levels of serum creatinine and cystatin C. BMC Nephrol 2019; 20:243. [PMID: 31272410 PMCID: PMC6610897 DOI: 10.1186/s12882-019-1436-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/24/2019] [Indexed: 11/29/2022] Open
Abstract
Background It remained lack of a kind of contrast-induced acute kidney injury (CI-AKI) model which was widely used in clinical practice and comparable to CI-AKI in humans. Methods Fifty Sprague-Dawley rats were divided into five groups of 10 rats each: (1) sham group (normal saline [NS] + NS); (2) NS plus low osmolality contrast medium (CM15) (NS + CM15); (3) furosemide (FM) plus NS (FM + NS); (4) FM + CM10; and (5) FM + CM15.We measured the levels of serum creatinine (SCr), cystatin C (cys-C) and histopathological scores of kidney tissues. Results SCr level in the FM + CM15 group were significantly increased after CM exposure compared with baseline levels (32.9 ± 4.57 vs. 158.7 ± 14.48 μmol/L, p < 0.001). Minor changes were found about the SCr levels between the pre- and post-exposure CM or NS treatment in the other groups. Additionally, the cys-C levels after CM exposure were increased compared with pretreatment levels in the FM + CM15 group (0.08 ± 0.03 vs. 0.18 ± 0.05 mg/L, p < 0.001). Minor changes were noted in the FM + NS group before and after NS administration. Only rats in the FM + CM15 group developed CI-AKI with the definitions of SCr or cys-C. Comparing to the FM + NS group, the histopathological scores were significantly increased in the FM + CM15 group. Conclusions A simple and reliable animal model for low osmolality contrast medium-induced AKI was established, which is similar to clinical CI-AKI based on different definitions for AKI.
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Affiliation(s)
- Yuan-Hui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, Guangdong, China
| | - Jin-Hua Xue
- Department of Physiology, School of Basic Medical Sciences, Gannan Medical University, Ganzhou, 341000, China
| | - Deng-Xuan Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, Guangdong, China
| | - Wei-Jie Bei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, Guangdong, China
| | - Kun Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, Guangdong, China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, Guangdong, China.
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, Guangdong, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, Guangdong, China.
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Wang Y, Shi Y, Xu X, Ge W, Yang S, Lu C. Effects of probucol on contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention. Medicine (Baltimore) 2019; 98:e16049. [PMID: 31232940 PMCID: PMC6636920 DOI: 10.1097/md.0000000000016049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study was performed to explore the effects of probucol on contrast-induced acute kidney injury (CIAKI) in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). METHODS In total, 220 patients undergoing PCI were randomly assigned to either the control group (hydration from 12 hours before to 12 hours after contrast administration; n = 110) or the probucol group (hydration plus probucol 500 mg twice daily 1 day before and 3 days after the operation; n = 110). The primary endpoint was the occurrence of serum creatinine (Scr)-based CIAKI, defined as an absolute increase in Scr by 0.5 mg/dl (44.2 μmol/L) or a relative 25% increase from baseline within 48 to 72 hours after exposure to contrast medium. The secondary outcomes were composite variations in Scr, blood urea nitrogen (BUN), creatinine clearance rate (Ccr) within 48 to 72 hours, and major adverse events during hospitalization or the 7-day follow-up period after PCI. RESULTS The overall incidence of Scr-based CIAKI was 7.3% (16/220): 5.5% (6/110) in the control group and 9.1% (10/110) in the probucol group (χ = 1.078, P = .298). There were no significant differences in the occurrence rate of major adverse events during hospitalization or the 7-day follow-up period after PCI between the groups. Multivariate logistic regression analysis showed that probucol was not an independent protective factor for CIAKI (odds ratio, 1.825; 95% confidence interval, 0.639-5.212; P = .261). However, hydration was an independent protective factor (odds ratio, 0.997; 95% confidence interval, 0.995-0.999; P = .004). CONCLUSION Probucol cannot effectively reduce the incidence of CIAKI through its anti-inflammatory and antioxidative stress effects.
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Affiliation(s)
- Yong Wang
- First Center Clinic College of Tianjin Medical University, Tianjin
- Department of Cardiology
| | - Yun Shi
- First Center Clinic College of Tianjin Medical University, Tianjin
| | | | | | - Shuo Yang
- Department of Hematology, The First People's Hospital of Shangqiu, Shangqiu, Henan
| | - Chengzhi Lu
- Department of Cardiology, Tianjin First Center Hospital, Tianjin, China
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Piayda K, Kleinebrecht L, Afzal S, Bullens R, Ter Horst I, Polzin A, Veulemans V, Dannenberg L, Wimmer AC, Jung C, Bönner F, Kelm M, Hellhammer K, Zeus T. Dynamic coronary roadmapping during percutaneous coronary intervention: a feasibility study. Eur J Med Res 2018; 23:36. [PMID: 30064500 PMCID: PMC6069549 DOI: 10.1186/s40001-018-0333-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A novel software ("Dynamic Coronary Roadmap") was developed, which offers a real-time, dynamic overlay of the coronary tree on fluoroscopy. Once the roadmap has been automatically generated during angiography it can be used for navigation during percutaneous coronary interventions (PCI). As a feasibility study, we aimed to investigate the feasibility of real-time dynamic coronary roadmapping and consecutive coronary overlay during elective PCI. METHODS AND RESULTS We studied 936 overlay runs, created following the same amount of angiographies, which were generated during 36 PCIs. Feasibility of dynamic coronary roadmapping was analyzed using a dedicated software tool. Roadmap quality (correct dynamic imaging of the vessels without relevant artefacts or missing parts) was distinguished from overlay quality (congruence of dynamic coronary roadmapping and coronary anatomy). Additionally, we assessed procedural success and the occurrence of major cardiac and cerebrovascular events (MACCE). Roadmap quality was defined as "fit for use" in 99.5%. In 97.4% of runs overlay quality was deemed "fit for use". Overall, we observed low inter and intra observer variability (ICC R = 0.84 for roadmap quality and R = 0.75 for overlay quality). Procedural success rate was 100%. MACCE occurred in two (5.6%) patients during post-interventional in-hospital stay and were not software-related. CONCLUSIONS Dynamic coronary roadmapping provides in > 98% of cases sufficient roadmap quality with an anatomically correct overlay of the coronary vessels with good inter and intra observer variability. Future randomized studies are warranted to test possible advantages like procedure time reduction and less consumption of contrast medium.
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Affiliation(s)
- Kerstin Piayda
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Laura Kleinebrecht
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Shazia Afzal
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | | | | | - Amin Polzin
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Verena Veulemans
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Lisa Dannenberg
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Anna Christina Wimmer
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Christian Jung
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Florian Bönner
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.,CARID (Cardiovascular Research Institute Düsseldorf), Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Katharina Hellhammer
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Tobias Zeus
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
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Mujtaba A, Taher MA, Hazza MA, Al-Rubaye HM, Kata AH, AbdulWahab H, AbdulBari A, AlRubay HK. The Effect of Spironolactone on the Incidence of Contrast-Induced Nephropathy in Patients Undergoing Cardiac Catheterization: Study Design and Rationale. Cardiol Ther 2018; 7:101-106. [PMID: 29785539 PMCID: PMC5986677 DOI: 10.1007/s40119-018-0112-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction Patients undergoing coronary catheterization are at high risk of developing contrast-induced nephropathy (CIN) acute kidney injury (AKI). Several approaches have been supposed to limit such an effect but with mixed results or non-practical methods. Spironolactone is supposed to be effective as a nephroprotective agent in animal studies. This study will try to measure the effect of spironolactone on the incidence of CIN-AKI in patients undergoing coronary catheterization (angiography angioplasty). Methods This study is a single-center, investigator-driven, double-blinded randomized controlled study in Iraq-Basra. More than 400 patients admitted for coronary angio unit in our center will be allocated in a 1:1 ratio to receive either spironolactone 200 mg single dose or placebo in addition to their usual premedication. Planned Outcomes Primary end point will be CIN defined as more than 25% or 0.3 mg/dl elevation in serum creatinine (S.Cr.) from baseline during the first 2–3 days after the procedure. We hope to identify or answer an important question regarding CIN in such high-risk patients. Trial Registration ClinicalTrials.gov Identifier, NCT03329443.
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Affiliation(s)
- Alhasan Mujtaba
- Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Basra, Iraq.
| | - Mohammed A Taher
- Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Basra, Iraq
| | - Mazin A Hazza
- College of Medicine, University of Basra, Basra, Iraq
| | | | - Asaad H Kata
- Basra Cardiac Catheterization Center, Basra, Iraq
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Cao B, Zhang C, Wang H, Xia M, Yang X. Renoprotective effect of remote ischemic postconditioning in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Ther Clin Risk Manag 2018; 14:369-375. [PMID: 29503556 PMCID: PMC5826247 DOI: 10.2147/tcrm.s158768] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Whether upper arm remote ischemic postconditioning (RIPostC) exerts protection to kidney in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains unknown. Methods Sixty-four patients with STEMI were randomized to PPCI + RIPostC (n=29) and PPCI (n=35) groups. RIPostC consisting of 4 cycles of 5 minutes occlusion/reperfusion by cuff inflation/deflation of the upper arm was started within 1 minute after the first balloon dilatation. Peripheral venous blood samples were collected before PPCI and at 0.5, 8, 24, 48, and 72 hours after PPCI to detect serum creatinine (SCr) and creatine kinase-MB (CK-MB). Acute kidney injury (AKI) rate and estimated glomerular filtration rate (eGFR) were calculated. The transthoracic echocardiography was performed 7 days after PPCI to assess left ventricular ejection fraction (LVEF). Results The patients in the PPCI + RIPostC group had a lower AKI rate compared with those in the PPCI group (P=0.04). The eGFR after PPCI increased in the PPCI + RIPostC group compared to the PPCI group (P<0.01). The peak of CK-MB concentration in the PPCI + RIPostC group was significantly lower than that in the PPCI group (P<0.01). The area under the curve of CK-MB decreased in the PPCI + RIPostC group compared with that in the PPCI group. LVEF in the PPCI + RIPostC group was significantly higher than that in the PPCI group (P=0.04). Conclusion Upper arm RIPostC exerts renal and cardiac protection following cardiac ischemia–reperfusion in patients with STEMI.
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Affiliation(s)
- Bangming Cao
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Chi Zhang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Haipeng Wang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Ming Xia
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Xiangjun Yang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
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Cao B, Wang H, Zhang C, Xia M, Yang X. Remote Ischemic Postconditioning (RIPC) of the Upper Arm Results in Protection from Cardiac Ischemia-Reperfusion Injury Following Primary Percutaneous Coronary Intervention (PCI) for Acute ST-Segment Elevation Myocardial Infarction (STEMI). Med Sci Monit 2018; 24:1017-1026. [PMID: 29456238 PMCID: PMC5827698 DOI: 10.12659/msm.908247] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the role of remote ischemic postconditioning (RIPC) of the upper arm on protection from cardiac ischemia-reperfusion injury following primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). MATERIAL AND METHODS Eighty patients with STEMI were randomized into two groups: primary PCI (N=44) and primary PCI+RIPC (N=36). RIPC consisted of four cycles of 5 minutes of occlusion and five minutes of reperfusion by cuff inflation and deflation of the upper arm, commencing within one minute of the first PCI balloon dilatation. Peripheral venous blood samples were collected before PCI and at 0.5, 8, 24, 48, and 72 hours after PCI. Levels of creatine kinase-MB (CK-MB), serum creatinine (Cr), nitric oxide (NO), and stromal cell-derived factor-1α (SDF-1α) were measured. The rates of acute kidney injury (AKI) and the estimated glomerular filtration rate (eGFR) were calculated. RESULTS Patients in the primary PCI+RIPC group, compared with the primary PCI group, had significantly lower peak CK-MB concentrations (P<0.01), a significantly increased left ventricular ejection fraction (LVEF) (P=0.01), a significantly lower rate of AKI (P<0.01) a significantly increased eGFR (P<0.01), and decreased area under the curve (AUC) of CK-MB, NO and SDF-1α. CONCLUSIONS RIPC of the upper arm following primary PCI in patients with acute STEMI might provide cardiac and renal protection from ischemia-reperfusion injury via the actions of SDF-1α, and NO.
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Affiliation(s)
- Bangming Cao
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Haipeng Wang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Chi Zhang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Ming Xia
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Xiangjun Yang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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Margolis G, Gal-Oz A, Letourneau-Shesaf S, Khoury S, Keren G, Shacham Y. Acute kidney injury based on the KDIGO criteria among ST elevation myocardial infarction patients treated by primary percutaneous intervention. J Nephrol 2017; 31:423-428. [PMID: 29185210 DOI: 10.1007/s40620-017-0461-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/03/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) following acute ST elevation myocardial infarction (STEMI) is associated with adverse outcomes. The recently proposed KDIGO criteria suggested modifications to the consensus classification system for AKI, namely lowering the threshold of increase in absolute serum creatinine and extending the time frame for AKI detection to 7 days. We evaluated the incidence, risk factors, and long-term mortality associated with AKI as classified by the KDIGO definition in a large single center cohort of consecutive STEMI patients. METHODS We retrospectively studied 2122 consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI). Recruited patients were admitted between January 2008 and May 2016 to the cardiac intensive care unit with the diagnosis of acute STEMI. We compared the utilization of the KDIGO and consensus criteria for the diagnosis of AKI and its relation to long term mortality. RESULTS The KDIGO criteria allowed the identification of more patients as having AKI (10.6 vs. 5.6%, p < 0.001) compared to the consensus criteria. Even mild elevation of serum creatinine (≥ 0.3 mg/dL) was associated with a marked increase in all-cause mortality (HR 4.7, 95% CI 3.1-6.43, p < 0.001). Patients with AKI whose renal function resolved prior to hospital discharge still had significantly higher mortality compared to patients with no AKI (23 vs. 8%, HR 3.1, 95% CI 2.09-4.90, p < 0.001). CONCLUSION KDIGO criteria is more sensitive than the consensus criteria in defining AKI in STEMI patients and identifying populations at risk for long term adverse outcomes.
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Affiliation(s)
- Gilad Margolis
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Amir Gal-Oz
- Department of Nephrology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sevan Letourneau-Shesaf
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Shafik Khoury
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel.
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Effect of Remote Ischemic Preconditioning on Perioperative Cardiac Events in Patients Undergoing Elective Percutaneous Coronary Intervention: A Meta-Analysis of 16 Randomized Trials. Cardiol Res Pract 2017; 2017:6907167. [PMID: 29062582 PMCID: PMC5618784 DOI: 10.1155/2017/6907167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/25/2017] [Accepted: 08/03/2017] [Indexed: 02/07/2023] Open
Abstract
Background The main objective of this meta-analysis was to investigate whether remote ischemic preconditioning (RIPC) reduces cardiac and renal events in patients undergoing elective cardiovascular interventions. Methods and Results We systematically searched articles published from 2006 to 2016 in PubMed, EMBASE, Web of Science, Cochrane Library, and Google Scholar. Odds ratios (ORs) with 95% confidence intervals (CIs) were used as the effect index for dichotomous variables. The standardized mean differences (SMDs) with 95% CIs were calculated as the pooled continuous effect. Sixteen RCTs of 2435 patients undergoing elective PCI were selected. Compared with control group, RIPC could significantly reduce the incidence of perioperative myocardial infarction (OR = 0.64; 95% CI: 0.48–0.86; P = 0.003) and acute kidney injury (OR = 0.56; 95% CI: 0.322–0.99; P = 0.049). Metaregression analysis showed that the reduction of PMI by RIPC was enhanced for CAD patients with multivessel disease (coef.: −0.05 [−0.09; −0.01], P = 0.022). There were no differences in the changes of cTnI (P = 0.934) and CRP (P = 0.075) in two groups. Conclusion Our meta-analysis of RCTs demonstrated that RIPC can provide cardiac and renal protection for patients undergoing elective PCI, while no beneficial effect on reducing the levels of cTnI and CRP after PCI was reported.
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Zagidullin NS, Dunayeva AR, Plechev VV, Gilmanov AZ, Zagidullin SZ, Er F, Pavlov VN. Nephroprotective effects of remote ischemic preconditioning in coronary angiography. Clin Hemorheol Microcirc 2017; 65:299-307. [PMID: 27814282 DOI: 10.3233/ch-16184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a formidable side effect of iodinated contrast medium use in subjects undergoing coronary angiogram (CAG). Remote ischemic preconditioning (RIPC) may reduce the risk of CIN. AIM The aim of the study was to investigate the nephroprotective effects of RIPC in coronary heart disease (CHD) in patients, undergoing CAG, with mild to moderate lowered estimated glomerular filtration rate (eGFR). MATERIALS In the randomized, blinded, sham RIPC (sRIPC) controlled study 51 patients with CHD and GFR less than 80 mL/min/m2, undergoing CAG, were investigated. The patients were randomized for RIPC (n = 26, 60.5±2.0 years) or sRIPC (n = 25, 62.96±1.7). RIPC was performed before the CAG by means of 3-5-minute cycle cuff pumped on the upper arm + 50 mm Hg above the systolic blood pressure (BP), while in sRIPC it corresponded to diastolic BP. The primary endpoint was the development of CIN and secondary - change of biomarkers (creatinine, urea, neutrophil gelatinase-associated lipocalin (NGAL), cystatin-C). RESULTS In RIPC group, CIN occurred in 28% of cases, while in sRIPC - 3.8%. All investigated markers increased in sRIPC and declined in RIPC; the difference was significant in markers between the groups before and after CAG. CONCLUSIONS RIPC proved nephroprotective effect in prevention of contrast-induced nephropathy in CHD subjects with mild to moderate lowered eGFR.
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Affiliation(s)
| | | | | | | | | | - Fikret Er
- Department of Internal Diseases, Klinikum Gütersloh, Department of Cardiology and Electrophysiology, Gutersloch, Germany
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Liu YH, Jiang L, Duan CY, He PC, Liu Y, Tan N, Chen JY. Canada Acute Coronary Syndrome Score: A Preprocedural Risk Score for Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention. Angiology 2017; 68:782-789. [PMID: 28135823 DOI: 10.1177/0003319717690674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention, contrast-induced nephropathy (CIN) is a serious complication associated with poor outcomes. We assessed the predictive value of the Canada Acute Coronary Syndrome (C-ACS) score for CIN in these patients. A total of 394 consecutive patients with STEMI were enrolled and divided into 3 groups according to their C-ACS scores—group 1, score 0; group 2, score 1; and group 3, score ≥2. The clinical outcomes were CIN and major adverse clinical events (MACEs) during hospital and follow-up; 8.4% of patients developed CIN. Patients with high C-ACS scores were more likely to develop CIN, in-hospital death, and MACEs ( P < .001). The C-ACS score was an independent predictor of CIN (odds ratio = 2.87; 95% confidence interval = 1.78-4.63; P < .001) and risk factor for long-term MACEs. The C-ACS score had good predictive values for CIN, in-hospital morality, MACEs, and long-term mortality. Patients with high C-ACS risk scores exhibited a worse survival rate than those with low scores (death, P = .02; MACEs, P = .006). In conclusion, in patients with STEMI, the C-ACS could predict CIN and clinical outcomes.
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Affiliation(s)
- Yuan-Hui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Lei Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Peng-Cheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
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Xu X, Hu J, Song N, Chen R, Zhang T, Ding X. Hyperuricemia increases the risk of acute kidney injury: a systematic review and meta-analysis. BMC Nephrol 2017; 18:27. [PMID: 28095822 PMCID: PMC5240269 DOI: 10.1186/s12882-016-0433-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 12/21/2016] [Indexed: 12/22/2022] Open
Abstract
Background Mounting evidence indicated that the elevated serum uric acid level was associated with an increased risk of acute kidney injury (AKI). Our goal was to systematically evaluate the correlation of serum uric acid (SUA) level and incidence of AKI by longitudinal cohort studies. Methods We searched electronic databases and the reference lists of relevant articles. 18 cohort studies with 75,200 patients were analyzed in this random-effect meta-analysis. Hyperuricemia was defined as SUA levels greater than 360-420 μmol/L (6–7 mg/dl), which was various according to different studies. Data including serum uric acid, serum creatinine, and incidence of AKI and hospital mortality were summarized using random-effects meta-analysis. Results The hyperuricemia group significantly exerted a higher risk of AKI compared to the controls (odds ratio OR 2.24, 95% CI 1.76-2.86, p < 0.01). Furthermore, there is less difference of the pooled rate of AKI after cardiac surgery between hyperuricemia and control group (34.3% vs 29.7%, OR 1.24, 95% CI 0.96-1.60, p = 0.10), while the rates after PCI were much higher in hyperuricemia group than that in control group (16.0% vs 5.3%, OR 3.24, 95% CI 1.93-5.45, p < 0.01). In addition, there were significant differences in baseline renal function at admission between hyperuricemia and control groups in most of the included studies. The relationship between hyperuricemia and hospital mortality was not significant. The pooled pre-operative SUA levels were higher in AKI group than that in the non-AKI group. Conclusions Elevated SUA level showed an increased risk for AKI in patients and measurements of SUA may help identify risks for AKI in these patients.
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Affiliation(s)
- Xialian Xu
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Kidney Disease and Blood Purification, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Jiachang Hu
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Kidney Disease and Blood Purification, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Nana Song
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Kidney Disease and Blood Purification, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Rongyi Chen
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Kidney Disease and Blood Purification, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Ting Zhang
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Kidney Disease and Blood Purification, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China. .,Shanghai Institute of Kidney Disease and Dialysis, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China. .,Shanghai Key Laboratory of Kidney Disease and Blood Purification, No.180 Fenglin Road, Shanghai, 200032, People's Republic of China.
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Prevention of post procedural acute kidney injury in the catheterization laboratory in a real-world population. Int J Cardiol 2017; 226:42-47. [DOI: 10.1016/j.ijcard.2016.10.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/04/2016] [Accepted: 10/09/2016] [Indexed: 02/02/2023]
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Jung SC, Kim CH, Ahn JH, Cho YD, Kang HS, Cho WS, Kim JE, Ahn C, Han MH. Endovascular Treatment of Intracranial Aneurysms in Patients With Autosomal Dominant Polycystic Kidney Disease. Neurosurgery 2016; 78:429-35; discussion 435. [PMID: 26492429 DOI: 10.1227/neu.0000000000001068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the outcome of endovascular treatment for intracranial aneurysms in patients with autosomal dominant polycystic kidney disease (ADPKD). OBJECTIVE To present clinical outcomes in terms of safety, effectiveness, and renal functions to assess contrast-induced nephropathy in endovascular coil embolization for intracranial aneurysms in ADPKD patients. METHODS Nineteen ADPKD patients (female:male, 15:4; mean age, 49.8 years; range, 20-67 years) had 26 aneurysms (mean size, 5.86 mm; range, 2.5-11.6 mm) and underwent 22 endovascular treatment sessions from 2001 to 2013. Four patients presented with ruptured aneurysms. Periprocedural complications, clinical outcomes with modified Rankin Scale scores, laboratory findings, and chronic kidney disease (CKD) stage before and after treatment were documented. Acute renal impairment was defined as serum creatinine (Cr) elevation by ≥ 0.5 mg/dL or 25% relative to baseline. RESULTS Symptomatic periprocedural complications developed after 1 endovascular procedure (1 of 22, 4.5%), and good clinical outcomes (modified Rankin Scale scores, 0-1) were achieved in 90% of patients (17 of 19). Overall, acute renal impairment occurred in 9.1% of treatment sessions (2 of 22). Acute renal impairment developed in 25% of high-risk patients (baseline Cr > 2.0 mg/dL) and 33.3% of baseline CKD stage 5 sessions but in none of the low-risk patients (baseline Cr ≤ 2.0 mg/dL) and in no CKD stage 1 to 4 sessions. CONCLUSION With appropriate management, coil embolization may be safe and effective for intracranial aneurysms in ADPKD. There is a concern about contrast-induced nephropathy in patients with CKD stage 5 or high serum Cr level (>2.0 mg/dL).
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Affiliation(s)
- Seung Chai Jung
- *Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; ‡Department of Neurology, Myongji Hospital, Goyang, Republic of Korea; §Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea; ¶Departments of Radiology, ‖Neurosurgery, and #Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Posma RA, Lexis CPH, Lipsic E, Nijsten MWN, Damman K, Touw DJ, van Veldhuisen DJ, van der Harst P, van der Horst ICC. Effect of Metformin on Renal Function After Primary Percutaneous Coronary Intervention in Patients Without Diabetes Presenting with ST-elevation Myocardial Infarction: Data from the GIPS-III Trial. Cardiovasc Drugs Ther 2016; 29:451-9. [PMID: 27656713 PMCID: PMC4636992 DOI: 10.1007/s10557-015-6618-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The association between metformin use and renal function needs further to be elucidated since data are insufficient whether metformin affects renal function in higher risk populations such as after ST-elevation myocardial infarction (STEMI). METHODS We studied 379 patients included in the GIPS-III trial in which patients without diabetes or renal dysfunction, who underwent primary percutaneous coronary interventions (PCI) for STEMI, were randomized to metformin 500 mg or placebo twice daily for four months. At baseline and at seven scheduled visits up to four months after PCI, estimated glomerular filtration rate (eGFR) was determined (2582 values). Contrast-induced acute kidney injury (CI-AKI) was defined as an increase in serum creatinine of ≥0.3 mg/dl or 25 % rise within 48 h after PCI. RESULTS At all visits, the mean eGFR was similar in patients randomized to metformin or placebo. Over the four month period, mixed-effect repeated-measures model analysis showed a least-squares mean ± standard error change in eGFR of -5.9±0.8 ml/min/1.73 m2 in the metformin group and −7.1 ±0.8 ml/min/1.73 m2 in the control group (P=0.27 for overall interaction). The incidence of CI-AKI was 14.8 %; 29 (15.2 %) patients in the metformin group versus 27 (14.4 %) controls (P=0.89). After adjustment for covariates, metformin treatment was not associated with CI-AKI (odds ratio: 0.96, 95%CI 0.52−1.75, P=0.88). CONCLUSION We conclude that initiation of metformin shortly after primary PCI has no adverse effect on renal function in patients without diabetes or prior renal impairment, further providing evidence of the safety of metformin use after myocardial infarction and subsequent contrast exposure.
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Affiliation(s)
- Rene A. Posma
- />Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Chris P. H. Lexis
- />Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik Lipsic
- />Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten W. N. Nijsten
- />Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Kevin Damman
- />Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daan J. Touw
- />Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dirk Jan van Veldhuisen
- />Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- />Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iwan C. C. van der Horst
- />Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Renoprotection by remote ischemic conditioning during elective coronary revascularization: A systematic review and meta-analysis of randomized controlled trials. Int J Cardiol 2016; 222:295-302. [PMID: 27498373 DOI: 10.1016/j.ijcard.2016.07.176] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/27/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Remote ischemic conditioning (RIC) has been recognized an emerging non-invasive approach for preventing acute kidney injury (AKI) in patients undergoing either elective coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). On the other hand, accumulating evidence has indicated the involving role of pre-CABG contrast usage for coronary angiography in post-surgery AKI risk. Along with the shortening time delay of CABG after coronary angiography, and the prevalent hybrid coronary revascularization (HCR), the AKI prevention by RIC has faced challenges following coronary revascuralization. METHODS Randomized controlled trials (RCTs) were searched from Pubmed, EMBase, and Cochrane library (until May 2016). The primary outcome was postoperative AKI. The second outcomes were included the requirement for renal replacement therapy (RRT), and in-hospital or 30-day mortality. RESULTS Twenty eligible RCTs (CABG, 3357 patients; PCI, 1501 patients) were selected. RIC significantly halved the incidence of AKI following PCI when compared with controls [n=1501; odds ratio (OR)=0.51; 95% CI, 0.32 to 0.82; P=0.006; I(2)=29.6%]. However, RIC did not affect the incidence of AKI following CABG (n=1850; OR=0.94; 95% CI, 0.73 to 1.19; P=0.586; I(2)=12.4%). The requirement for RRT and in-hospital mortality was not affected by RIC in CABG (n=2049, OR=1.04, P=0.87; n=1920, OR=0.89, P=0.7; respectively). CONCLUSIONS Our meta-analysis suggests that RIC for preventing AKI following CABG has faced with challenges in terms of AKI, the requirement for RRT, and mortality. However, RIC shows a renoprotective benefit for PCI. Hence, our findings may infer the preserved renal effects of RIC in CABG with preconditioning before the coronary angiography, or in HCR.
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Contrast Medium Induced Nephropathy after Endovascular Stent Graft Placement: An Examination of Its Prevalence and Risk Factors. Radiol Res Pract 2016; 2016:5950986. [PMID: 27069685 PMCID: PMC4812477 DOI: 10.1155/2016/5950986] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/14/2016] [Indexed: 12/31/2022] Open
Abstract
Endovascular stent graft placement has become a major treatment for thoracic and abdominal aneurysms. While endovascular therapy is less invasive than open surgery, it involves the use of a contrast medium. Contrast media can cause renal impairment, a condition termed as contrast-induced nephropathy (CIN). This study sought to evaluate the incidence and risk factors of CIN following endovascular stent graft placement for aortic aneurysm repair. The study included 167 consecutive patients who underwent endovascular stent graft placement in our hospital from October 2013 to June 2014. CIN was diagnosed using the European Society of Urogenital Radiology criteria. Patients with and without CIN were compared. Chi-squared tests, t-tests, and multivariate logistic regression analyses were performed. Thirteen patients (7.8%) developed CIN. Left ventricular dysfunction and intraoperative blood transfusion were significantly more frequent in the CIN group (P = 0.017 and P = 0.032, resp.). Multivariate analysis showed that left ventricular dysfunction had the strongest influence on CIN development (odds ratio 9.34, P = 0.018, and 95% CI = 1.46–59.7). Patients with CIN also experienced longer ICU and hospital stays. Measures to improve renal perfusion flow should be considered for patients with left ventricular dysfunction who are undergoing endovascular stent graft placement.
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Acute kidney injury among ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention: a multifactorial entity. J Nephrol 2016; 29:169-174. [PMID: 26861658 DOI: 10.1007/s40620-015-0255-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/27/2015] [Indexed: 12/16/2022]
Abstract
Acute kidney injury is a frequent complication among ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), and is associated with adverse outcomes. While contrast nephropathy is considered the most important reason for worsening of renal function, recent data have suggested the role of other important factors among this specific patient population. In the present review, we examine the various factors leading to renal impairment in STEMI patients and place the findings in the context of this specific patient population in the era of primary PCI. These factors include contrast nephropathy, time to coronary reperfusion, cardiac pump function and hemodynamics as well as various inflammatory and metabolic markers.
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Dong Y, Zhang B, Liang L, Lian Z, Liu J, Liang C, Zhang S. How Strong Is the Evidence for Sodium Bicarbonate to Prevent Contrast-Induced Acute Kidney Injury After Coronary Angiography and Percutaneous Coronary Intervention? Medicine (Baltimore) 2016; 95:e2715. [PMID: 26886610 PMCID: PMC4998610 DOI: 10.1097/md.0000000000002715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/30/2015] [Accepted: 01/11/2016] [Indexed: 02/05/2023] Open
Abstract
Hydration with sodium bicarbonate is one of the strategies to prevent contrast-induced acute kidney injury (CI-AKI). The purpose of this study was to determine how strong is the evidence for sodium bicarbonate to prevent CI-AKI after coronary angiography (CAG) and/or percutaneous coronary intervention (PCI).We conducted PubMed, EMBASE, and CENTRAL databases to search for randomized controlled trials (RCTs) comparing the efficacy of sodium bicarbonate with sodium chloride to prevent CI-AKI after CAG and/or PCI. Relative risk (RR), standardized mean difference (SMD), or weighted mean difference (WMD) with 95% confidence intervals (CIs) was calculated. Heterogeneity, publication bias, and study quality were evaluated, sensitivity analyses, cumulative analyses, and subgroup analyses were performed. The risk of random errors was assessed by trial sequential analysis (TSA).Sixteen RCTs (3537 patients) met the eligibility criteria. Hydration with sodium bicarbonate showed significant beneficial effects in preventing CI-AKI (RR 0.67; 95% CI: 0.47-0.96, P = 0.029), decreasing the change in serum creatinine (SCr) (SMD -0.31 95% CI: -0.55 to -0.07, P = 0.011) and estimated glomerular filtration rate (eGFR) (SMD -0.17 95% CI: -0.30 to -0.04, P = 0.013). But no significant differences were observed in the requirement for dialysis (RR 1.11; 95% CI: 0.60-2.07, P = 0.729), mortality (RR 0.71; 95% CI: 0.41-1.21, P = 0.204) and reducing the length of hospital stay (LHS) (WMD -1.47; 95% CI: -4.14 to 1.20, P = 0.279). The result of TSA on incidence of CI-AKI showed the required information size (RIS = 6614) was not reached and cumulative z curve did not cross TSA boundary. The result of TSA on the requirement for dialysis and mortality demonstrated the required information sizes (RIS = 170,510 and 19,516, respectively) were not reached, and the cumulative z-curve did not cross any boundaries.The evidence that sodium bicarbonate reduces the incidence of CI-AKI is encouraging but more well-designed randomized controlled trails are required to allow definitive firm conclusion to be drawn.
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Affiliation(s)
- Yuhao Dong
- From the Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong Province (YD, BZ, LL, ZL, JL, CL, SZ); Shantou University Medical College, Shantou (YD); and Graduate College, Southern Medical University, Guangzhou, China (BZ, LL)
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De Francesco M, Ronco C, Wacinski PJ, Wessely R, Hernández F, Lamotte M. Economic impact of contrast-induced acute kidney injury associated with invasive cardiology: role of iso-osmolar contrast media in Germany, Italy, Poland, and Spain. J Med Econ 2016; 19:158-68. [PMID: 26451530 DOI: 10.3111/13696998.2015.1105809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Iso-osmolar Iodixanol is associated with a lower rate of contrast-induced acute kidney injury (CI-AKI) in patients at increased risk compared to low-osmolar contrast media (LOCM). The aim of this study was to assess the financial consequences of CI-AKI risk reduction in patients undergoing coronary angiography (CA) with or without percutaneous coronary intervention (PCI) in German, Italian, Polish and Spanish hospitals. METHODS This budget impact analysis (BIA) compared a scenario with iodixanol to a scenario without, where only LOCM were used, in patients at increased risk of CI-AKI over a 3-year horizon. A meta-analysis based on a systematic review observed a lower rate of CI-AKI with iodixanol compared to LOCM (Risk Reduction = 0.46) in patients with underlying impaired renal function (serum creatinine ≥1.6 mg/dl and estimated glomerular filtration rate ≤50 ml/min/1.73 m(2)). Contrast media and CI-AKI hospitalization costs were included in the analysis and unit costs were obtained from published literature, official sources or, when available, from hospital data. In the absence of country-specific data, resource utilization for a CI-AKI hospitalization was obtained by interviews with local clinicians in each country. The percentage of patients who received iodixanol was assumed to increase over time. RESULTS Based on a percentage of patients at increased risk of CI-AKI equal to 20% in Germany, 24% in Italy, 23% in Poland and 10% in Spain, results showed that the introduction of iodixanol would bring a 3-years cumulative net percentage saving on the total hospital budget of 29%, 34%, 25%, and 33% in the four countries respectively. CONCLUSION The results of the analysis for the four countries showed that iodixanol use in patients at increased risk of CI-AKI undergoing CA with or without PCI may bring considerable savings on the hospital's budget, due to the associated reduction in CI-AKI incidence.
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Affiliation(s)
| | | | | | - Rainer Wessely
- d d Zentrum für Herz- Gefäss- und Lungenmedizin , Köln , Germany
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Patel N, Baker SM, Walters RW, Kaja A, Kandasamy V, Abuzaid A, Modrykamien AM. Serum hyperchloremia as a risk factor for acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Proc AMIA Symp 2016; 29:7-11. [PMID: 26722155 PMCID: PMC4677840 DOI: 10.1080/08998280.2016.11929341] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
A high serum chloride concentration has been associated with the development of acute kidney injury in critically ill patients. However, the association between hyperchloremia and acute kidney injury (AKI) in patients admitted with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) is unknown. A retrospective analysis of consecutive patients admitted with the diagnosis of STEMI and treated with PCI was performed. Subjects were classified as having hyper- or normochloremia based upon their admission serum chloride level. Multivariable logistic regression analyses were employed for the primary and secondary outcomes. The primary analysis evaluated whether high serum chloride on admission was associated with the development of AKI after adjusting for age, diabetes mellitus, admission systolic blood pressure, contrast volume used during angiography, Killip class, and need for vasopressor therapy or intraaortic balloon pump. The secondary analyses evaluated whether high serum chloride was associated with sustained ventricular tachycardia or fibrillation. Of 291 patients (26.1% female, mean age of 59.9 ± 12.6 years, and mean body mass index of 29.3 ± 6.1 kg/m(2)), 25 (8.6%) developed AKI. High serum chloride on admission did not contribute significantly to the development of AKI (odds ratio, 95%; confidence interval, 0.90 to 1.24). In addition, serum chloride on admission was not significantly associated with sustained ventricular tachycardia or fibrillation after adjusting for demographic and clinical covariates. In conclusion, our study demonstrated no association between baseline serum hyperchloremia and an increased risk of AKI in patients admitted with STEMI treated with PCI.
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Affiliation(s)
- Nachiket Patel
- Division of Cardiology University of Florida College of Medicine, Jacksonville (Patel); the Division of Clinical Research and Evaluative Sciences (Walters) and Division of General Internal Medicine (Kaja, Kandasamy, Abuzaid), Creighton University School of Medicine, Omaha, Nebraska; Intensive Care Unit, Alegent-Creighton Health, Creighton University Medical Center, Omaha, Nebraska (Baker); and Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Modrykamien)
| | - Sarah M Baker
- Division of Cardiology University of Florida College of Medicine, Jacksonville (Patel); the Division of Clinical Research and Evaluative Sciences (Walters) and Division of General Internal Medicine (Kaja, Kandasamy, Abuzaid), Creighton University School of Medicine, Omaha, Nebraska; Intensive Care Unit, Alegent-Creighton Health, Creighton University Medical Center, Omaha, Nebraska (Baker); and Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Modrykamien)
| | - Ryan W Walters
- Division of Cardiology University of Florida College of Medicine, Jacksonville (Patel); the Division of Clinical Research and Evaluative Sciences (Walters) and Division of General Internal Medicine (Kaja, Kandasamy, Abuzaid), Creighton University School of Medicine, Omaha, Nebraska; Intensive Care Unit, Alegent-Creighton Health, Creighton University Medical Center, Omaha, Nebraska (Baker); and Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Modrykamien)
| | - Ajay Kaja
- Division of Cardiology University of Florida College of Medicine, Jacksonville (Patel); the Division of Clinical Research and Evaluative Sciences (Walters) and Division of General Internal Medicine (Kaja, Kandasamy, Abuzaid), Creighton University School of Medicine, Omaha, Nebraska; Intensive Care Unit, Alegent-Creighton Health, Creighton University Medical Center, Omaha, Nebraska (Baker); and Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Modrykamien)
| | - Vimalkumar Kandasamy
- Division of Cardiology University of Florida College of Medicine, Jacksonville (Patel); the Division of Clinical Research and Evaluative Sciences (Walters) and Division of General Internal Medicine (Kaja, Kandasamy, Abuzaid), Creighton University School of Medicine, Omaha, Nebraska; Intensive Care Unit, Alegent-Creighton Health, Creighton University Medical Center, Omaha, Nebraska (Baker); and Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Modrykamien)
| | - Ahmed Abuzaid
- Division of Cardiology University of Florida College of Medicine, Jacksonville (Patel); the Division of Clinical Research and Evaluative Sciences (Walters) and Division of General Internal Medicine (Kaja, Kandasamy, Abuzaid), Creighton University School of Medicine, Omaha, Nebraska; Intensive Care Unit, Alegent-Creighton Health, Creighton University Medical Center, Omaha, Nebraska (Baker); and Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Modrykamien)
| | - Ariel M Modrykamien
- Division of Cardiology University of Florida College of Medicine, Jacksonville (Patel); the Division of Clinical Research and Evaluative Sciences (Walters) and Division of General Internal Medicine (Kaja, Kandasamy, Abuzaid), Creighton University School of Medicine, Omaha, Nebraska; Intensive Care Unit, Alegent-Creighton Health, Creighton University Medical Center, Omaha, Nebraska (Baker); and Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center at Dallas, Dallas, Texas (Modrykamien)
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Lauridsen MD, Gammelager H, Schmidt M, Rasmussen TB, Shaw RE, Bøtker HE, Sørensen HT, Christiansen CF. Acute kidney injury treated with renal replacement therapy and 5-year mortality after myocardial infarction-related cardiogenic shock: a nationwide population-based cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:452. [PMID: 26715162 PMCID: PMC4699352 DOI: 10.1186/s13054-015-1170-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/15/2015] [Indexed: 12/18/2022]
Abstract
Background Myocardial infarction-related cardiogenic shock is frequently complicated by acute kidney injury. We examined the influence of acute kidney injury treated with renal replacement therapy (AKI-RRT) on risk of chronic dialysis and mortality, and assessed the role of comorbidity in patients with cardiogenic shock. Methods In this Danish cohort study conducted during 2005–2012, we used population-based medical registries to identify patients diagnosed with first-time myocardial infarction-related cardiogenic shock and assessed their AKI-RRT status. We computed the in-hospital mortality risk and adjusted relative risk. For hospital survivors, we computed 5-year cumulative risk of chronic dialysis accounting for competing risk of death. Mortality after discharge was computed with use of Kaplan-Meier methods. We computed 5-year hazard ratios for chronic dialysis and death after discharge, comparing AKI-RRT with non-AKI-RRT patients using a propensity score-adjusted Cox regression model. Results We identified 5079 patients with cardiogenic shock, among whom 13 % had AKI-RRT. The in-hospital mortality was 62 % for AKI-RRT patients, and 36 % for non-AKI-RRT patients. AKI-RRT remained associated with increased in-hospital mortality after adjustment for confounders (relative risk = 1.70, 95 % confidence interval (CI): 1.59–1.81). Among the 3059 hospital survivors, the 5-year risk of chronic dialysis was 11 % (95 % CI: 8–16 %) for AKI-RRT patients, and 1 % (95 % CI: 0.5–1 %) for non-AKI-RRT patients (adjusted hazard ratio: 15.9 (95 % CI: 8.7–29.3). The 5-year mortality was 43 % (95 % CI: 37–53 %) for AKI-RRT patients compared with 29 % (95 % CI: 29–31 %) for non-AKI-RRT patients. The adjusted 5-year hazard ratio for death was 1.55 (95 % CI: 1.22–1.96) for AKI-RRT patients compared with non-AKI-RRT patients. In patients with comorbidity, absolute mortality increased while relative impact of AKI-RRT on mortality decreased. Conclusion AKI-RRT following myocardial infarction-related cardiogenic shock predicted elevated short-term mortality and long-term risk of chronic dialysis and mortality. The impact of AKI-RRT declined with increasing comorbidity suggesting that intensive treatment of AKI-RRT should be accompanied with optimized treatment of comorbidity when possible. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-1170-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie Dam Lauridsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200, Aarhus N, Denmark. .,California Pacific Medical Institute Research Institute, 475 Brannan, Suite 220, San Francisco, CA, 94107, USA.
| | - Henrik Gammelager
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200, Aarhus N, Denmark. .,Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200, Aarhus N, Denmark.
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200, Aarhus N, Denmark. .,Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200, Aarhus N, Denmark.
| | - Thomas Bøjer Rasmussen
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200, Aarhus N, Denmark.
| | - Richard E Shaw
- Division of Cardiology, California Pacific Medical Center, 2200 Webster Street, San Francisco, CA, 94115, USA.
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200, Aarhus N, Denmark.
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200, Aarhus N, Denmark.
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle 43-45, 8200, Aarhus N, Denmark.
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Contrast Induced Nephropathy and Long-term Renal Decline After Percutaneous Transluminal Angioplasty for Symptomatic Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2015; 51:386-93. [PMID: 26460289 DOI: 10.1016/j.ejvs.2015.08.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/26/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE/BACKGROUND Administration of iodinated contrast media during endovascular procedures for peripheral arterial disease (PAD) may cause contrast induced nephropathy (CIN). The aim of the present study was to establish the incidence of CIN after these procedures and to study its association with long-term loss of kidney function, cardiovascular events, and death. METHODS Consecutive patients first presenting with symptomatic PAD (Rutherford classification II-VI) who were treated with an endovascular procedure were included in this prospective observational cohort study. CIN was defined as >25% increase of serum creatinine concentration from baseline at 5 days after the intervention. RESULTS Some 337 patients were included with a mean estimated glomerular filtration rate (eGFR) of 67 mL/minute. Thirteen percent (95% confidence interval [CI] 9-16) of these patients developed CIN after endovascular interventions for PAD. One year after treatment, eGFR was reduced by 12.4 mL/minute (95% CI 8.6-16.2) in patients with CIN compared with 6.2 mL/minute (95% CI 4.9-7.0) in patients without acute kidney injury (p < .01). After correction for potential confounders, CIN was associated with a 7.8 mL/minute (95% CI 4.5-11.0) reduction of eGFR at 1 year after endovascular intervention (p < .01). Furthermore, patients with CIN were at increased risk of long-term cardiovascular events and mortality. CONCLUSION Exposure to iodinated contrast media during endovascular procedures for symptomatic PAD frequently results in CIN. Patients with CIN are at increased risk of long-term loss of renal function, cardiovascular events, and death.
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Peng PA, Wang L, Ma Q, Xin Y, Zhang O, Han HY, Liu XL, Ji QW, Zhou YJ, Zhao YX. Valsartan protects HK-2 cells from contrast media-induced apoptosis by inhibiting endoplasmic reticulum stress. Cell Biol Int 2015; 39:1408-17. [PMID: 26248489 DOI: 10.1002/cbin.10521] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/01/2015] [Indexed: 01/16/2023]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is associated with increasing in-hospital and long-term adverse clinical outcomes in high-risk patients undergoing percutaneous coronary intervention (PCI). Contrast media (CM)-induced renal tubular cell apoptosis is reported to participate in this process by activating endoplasmic reticulum (ER) stress. An angiotensin II type 1 receptor (AT1R) antagonist can alleviate ER stress-induced renal apoptosis in streptozotocin (STZ)-induced diabetic mice and can reduce CM-induced renal apoptosis by reducing oxidative stress and reversing the enhancement of bax mRNA and the reduction of bcl-2 mRNA, but the effect of the AT1R blocker on ER stress in the pathogenesis of CI-AKI is still unknown. In this study, we explored the effect of valsartan on meglumine diatrizoate-induced human renal tubular cell apoptosis by measuring changes in ER stress-related biomarkers. The results showed that meglumine diatrizoate caused significant cell apoptosis by up-regulating the expression of ER stress markers, including glucose-regulated protein 78 (GRP78), activating transcription factor 4 (ATF4), CCAAT/enhancer-binding protein-homologous protein (CHOP) and caspase 12, in a time- and dose-dependent manner, which could be alleviated by preincubation with valsartan. In conclusion, valsartan had a potential nephroprotective effect on meglumine diatrizoate-induced renal cell apoptosis by inhibiting ER stress.
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Affiliation(s)
- Ping-An Peng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Le Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Qian Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yi Xin
- Experimental Center, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Ou Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Hong-Ya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xiao-Li Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Qing-Wei Ji
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yu-Jie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Ying-Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
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Zhao K, Li Y, Gao Q. Role of red blood cell distribution width in predicting contrast induced nephropathy in patients with stable angina pectoris undergoing percutaneous coronary intervention. Int J Cardiol 2015; 197:276-8. [PMID: 26142973 DOI: 10.1016/j.ijcard.2015.06.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/19/2015] [Indexed: 01/02/2023]
Affiliation(s)
- Kai Zhao
- Department of Cardiology, Tianjin Nankai Hospital, Tianjin 300100, People's Republic of China.
| | - Yongjian Li
- Department of Cardiology, Tianjin Nankai Hospital, Tianjin 300100, People's Republic of China
| | - Qiaoying Gao
- Department of Pharmacology, Institute of Acute Abdominal Diseases, Tianjin Nankai Hospital, Tianjin 300100, People's Republic of China
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Liu Y, Liu YH, Tan N, Chen JY, Zhou YL, Duan CY, Li HL, Chen PY. Novel risk scoring for pre-procedural prediction of contrast-induced nephropathy and poor long-term outcomes among patients with chronic total occlusion undergoing percutaneous coronary intervention. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Peng P, Ma Q, Wang L, Zhang O, Han H, Liu X, Zhou Y, Zhao Y. Preconditioning With Tauroursodeoxycholic Acid Protects Against Contrast-Induced HK-2 Cell Apoptosis by Inhibiting Endoplasmic Reticulum Stress. Angiology 2015; 66:941-9. [DOI: 10.1177/0003319715575965] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To investigate whether tauroursodeoxycholic acid (TUDCA) could attenuate contrast media (CM)-induced renal tubular cell apoptosis by inhibiting endoplasmic reticulum stress (ERS), we exposed HK-2 cells to increasing doses of meglumine diatrizoate (20, 40, and 80 mg I/mL) for 2 to 16 hours, with/without TUDCA preconditioning for 24 hours. Cell viability test, Hoechst 33258 staining, and flow cytometry were used to detect meglumine diatrizoate-induced cell apoptosis, while real-time polymerase chain reaction and Western blot analysis were used to measure the expressions of ERS markers of glucose-regulated protein 78 (GRP78), activating transcription factor 4 (ATF4), and the apoptosis-related marker of caspase 12. Cell apoptosis and messenger RNA (mRNA) expression of GRP78 ( P = .005), ATF4 ( P = .01), and caspase 12 ( P = .001) were significantly higher in the CM 4 hours group than the control as well as the protein expressions. The TUDCA preconditioning reduced the mRNA expression of GRP78, ATF4, and caspase 12 in the CM 4 hours groups ( P = .009, .019, and .003, respectively) as well as the protein expression. In conclusion, TUDCA could protect renal tubular cells from meglumine diatrizoate-induced apoptosis by inhibiting ERS.
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Affiliation(s)
- Pingan Peng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Qian Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Le Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Ou Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Xiaoli Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Yingxin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
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Shacham Y, Leshem-Rubinow E, Gal-Oz A, Ben-Assa E, Steinvil A, Keren G, Roth A, Arbel Y. Relation of in-hospital serum creatinine change patterns and outcomes among ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Clin Cardiol 2015; 38:274-9. [PMID: 25639761 DOI: 10.1002/clc.22384] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The worsening of serum creatinine (sCr) level is a frequent finding among ST-segment elevation MI (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), associated with adverse short-term and long-term outcomes. No information is present, however, regarding the incidence and prognostic implications associated with an improvement in sCr levels throughout hospitalization, as compared with admission levels. HYPOTHESIS Reversible renal impairment prior to PCI is not associated with adverse outcomes. METHODS We retrospectively studied 1260 STEMI patients undergoing primary PCI. The incidence of in-hospital complications and long-term mortality was compared between patients having stable, worsened (>0.3 mg/dL increase), or improved (>0.3 mg/dL decrease) sCr levels throughout hospitalization. RESULTS Overall, 127 patients (10%) had worsening in sCr levels, whereas 44 (3.5%) had an improvement of sCr compared with admission levels. Patients with worsening sCR had more complications during hospitalization, higher 30-day (13% vs 1%; P < 0.001) and up to 5-year all-cause mortality (28% vs 5%; P < 0.001) compared with those with stable sCR. No significant difference was found regarding complications and mortality between patients having an improvement in sCr and stable sCr. Compared with patients with stable sCr, the adjusted hazard ratio for all-cause mortality in patients with worsened sCr was 6.68 (95% confidence interval: 2.1-21.6, P = 0.002). CONCLUSIONS In STEMI patients undergoing primary PCI, renal impairment prior to PCI is a frequent finding. In contrast to post-PCI sCr worsening, this entity is not associated with adverse short-term and long-term outcomes.
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Affiliation(s)
- Yacov Shacham
- Department of Cardiology, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Amir Gal-Oz
- Department of Nephrology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Ben-Assa
- Department of Cardiology, Tel-Aviv University, Tel-Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel-Aviv University, Tel-Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel-Aviv University, Tel-Aviv, Israel
| | - Arie Roth
- Department of Cardiology, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel-Aviv University, Tel-Aviv, Israel
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Zuo B, Wang F, Song Z, Xu M, Wang G. Using remote ischemic conditioning to reduce acute kidney injury in patients undergoing percutaneous coronary intervention: a meta-analysis. Curr Med Res Opin 2015; 31:1677-85. [PMID: 26154745 DOI: 10.1185/03007995.2015.1066766] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS It remains uncertain whether remote ischemic conditioning (RIC) could prevent acute kidney injury (AKI) in patients undergoing percutaneous coronary intervention (PCI). Thus, this meta-analysis aiming to explore the renoprotective role of RIC in patients undergoing PCI was carried out. METHODS PubMed, Web of Science, and Cochrane Library were searched from inception to 31 December 2014 to identify eligible randomized controlled trials. Pooled risk ratio, mean, standard deviation and 95% CI were used to assess the effect by fixed- or random-effect models. Heterogeneity was assessed by the Cochran Q and I( 2) statistics. RESULTS Nine trials were included in this study. RIC decreased the AKI incidence in patients undergoing PCI compared with control individuals (P < 0.001; RR, 0.53; 95% CI, 0.39-0.71; P for heterogeneity = 0.15; heterogeneity χ(2 )= 13.38; I(2 )= 33%). Besides, limb conditioning attenuated AKI (P = 0.001; RR, 0.57; 95% CI, 0.41-0.81; P for heterogeneity = 0.13; heterogeneity χ(2 )= 12.48; I(2 )= 36%). Remote postconditioning may reduce the AKI incidence (P = 0.03; RR, 0.65; 95% CI, 0.44-0.97; P for heterogeneity = 0.15; heterogeneity χ(2 )= 5.36; I(2 )= 44%); remote preconditioning could also play a renoprotective role (P < 0.001; RR, 0.42; 95% CI, 0.27-0.65; P for heterogeneity = 0.31; heterogeneity χ(2 )= 5.98; I(2 )= 16%). CONCLUSIONS RIC may not only confer cardioprotection, but also reduce the incidence of AKI in patients undergoing PCI, ultimately leading to better clinical outcomes. RIC may potentially be a powerful approach conferring protection in patients undergoing PCI in future clinical practice. More large-scale trials are required to obtain a more reliable conclusion.
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Affiliation(s)
- Bo Zuo
- a a Department of Cardiology , Peking University Third Hospital and Key Laboratory of Cardiovascular Molecular Biology and Regulatory peptides, Ministry of Health , Beijing , China
| | - Fuhua Wang
- a a Department of Cardiology , Peking University Third Hospital and Key Laboratory of Cardiovascular Molecular Biology and Regulatory peptides, Ministry of Health , Beijing , China
| | - Zhu Song
- a a Department of Cardiology , Peking University Third Hospital and Key Laboratory of Cardiovascular Molecular Biology and Regulatory peptides, Ministry of Health , Beijing , China
| | - Ming Xu
- b b Institute of Vascular Medicine, Peking University Third Hospital and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education , Beijing , China
| | - Guisong Wang
- a a Department of Cardiology , Peking University Third Hospital and Key Laboratory of Cardiovascular Molecular Biology and Regulatory peptides, Ministry of Health , Beijing , China
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Pickard JMJ, Bøtker HE, Crimi G, Davidson B, Davidson SM, Dutka D, Ferdinandy P, Ganske R, Garcia-Dorado D, Giricz Z, Gourine AV, Heusch G, Kharbanda R, Kleinbongard P, MacAllister R, McIntyre C, Meybohm P, Prunier F, Redington A, Robertson NJ, Suleiman MS, Vanezis A, Walsh S, Yellon DM, Hausenloy DJ. Remote ischemic conditioning: from experimental observation to clinical application: report from the 8th Biennial Hatter Cardiovascular Institute Workshop. Basic Res Cardiol 2014; 110:453. [PMID: 25449895 PMCID: PMC4250562 DOI: 10.1007/s00395-014-0453-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 11/14/2014] [Indexed: 12/20/2022]
Abstract
In 1993, Przyklenk and colleagues made the intriguing experimental observation that ‘brief ischemia in one vascular bed also protects remote, virgin myocardium from subsequent sustained coronary artery occlusion’ and that this effect ‘…. may be mediated by factor(s) activated, produced, or transported throughout the heart during brief ischemia/reperfusion’. This seminal study laid the foundation for the discovery of ‘remote ischemic conditioning’ (RIC), a phenomenon in which the heart is protected from the detrimental effects of acute ischemia/reperfusion injury (IRI), by applying cycles of brief ischemia and reperfusion to an organ or tissue remote from the heart. The concept of RIC quickly evolved to extend beyond the heart, encompassing inter-organ protection against acute IRI. The crucial discovery that the protective RIC stimulus could be applied non-invasively, by simply inflating and deflating a blood pressure cuff placed on the upper arm to induce cycles of brief ischemia and reperfusion, has facilitated the translation of RIC into the clinical setting. Despite intensive investigation over the last 20 years, the underlying mechanisms continue to elude researchers. In the 8th Biennial Hatter Cardiovascular Institute Workshop, recent developments in the field of RIC were discussed with a focus on new insights into the underlying mechanisms, the diversity of non-cardiac protection, new clinical applications, and large outcome studies. The scientific advances made in this field of research highlight the journey that RIC has made from being an intriguing experimental observation to a clinical application with patient benefit.
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Affiliation(s)
- Jack M. J. Pickard
- The Hatter Cardiovascular Institute, University College London Hospital and Medical School, 67 Chenies Mews, London, WC1E 6HX UK
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark
| | - Gabriele Crimi
- Cardiology Department, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | | | - Sean M. Davidson
- The Hatter Cardiovascular Institute, University College London Hospital and Medical School, 67 Chenies Mews, London, WC1E 6HX UK
| | - David Dutka
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Peter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | | | | | - Zoltan Giricz
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | | | | | | | | | | | - Christopher McIntyre
- SchulichSchool of Medicine and Dentistry, University of Western Ontario, Ontario, Canada
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Fabrice Prunier
- Cardiology Department, L’UNAM Université, University of Angers, EA3860 Cardioprotection, Remodelage et Thrombose, University Hospital, Angers, France
| | - Andrew Redington
- The Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Nicola J. Robertson
- Neonatology, Institute for Women’s Health, University College London, London, WC1E 6HX UK
| | - M. Saadeh Suleiman
- Bristol Heart Institute Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
| | - Andrew Vanezis
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Derek M. Yellon
- The Hatter Cardiovascular Institute, University College London Hospital and Medical School, 67 Chenies Mews, London, WC1E 6HX UK
| | - Derek J. Hausenloy
- The Hatter Cardiovascular Institute, University College London Hospital and Medical School, 67 Chenies Mews, London, WC1E 6HX UK
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Cortese B, Sciahbasi A, Sebik R, Rigattieri S, Alonzo A, Silva-Orrego P, Belloni F, Seregni RG, Giovannelli F, Tespili M, Ricci R, Berni A. Comparison of risk of acute kidney injury after primary percutaneous coronary interventions with the transradial approach versus the transfemoral approach (from the PRIPITENA urban registry). Am J Cardiol 2014; 114:820-5. [PMID: 25073568 DOI: 10.1016/j.amjcard.2014.06.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 01/13/2023]
Abstract
The risk of acute kidney injury (AKI) is a major issue after percutaneous coronary interventions (PCIs), especially in the setting of ST-elevation myocardial infarction. Preliminary data from large retrospective registries seem to show a reduction of AKI when a transradial (TR) approach for PCI is adopted. Little is known about the relation between vascular access and AKI after emergent PCI. We here report the results of the Primary PCI from Tevere to Navigli (PRIPITENA), a retrospective database of primary PCI performed at high-volume centers in the urban areas of Rome and Milan. Primary end point of this study was the occurrence of AKI in the TR and transfemoral (TF) access site groups. Secondary end points were major adverse cardiovascular events, stent thrombosis, and Thrombolysis in Myocardial Infarction major and minor bleedings. The database included 1,330 patients, 836 treated with a TR and 494 with a TF approach. After a propensity-matched analysis performed to exclude possible confounders, we identified 450 matched patients (225 TR and 225 TF). The incidence of AKI in the 2 matched groups was lower in patients treated with TR primary PCI (8.4% vs 16.9%, p = 0.007). Major adverse cardiovascular events and stent thrombosis were not different among study groups, whereas major bleedings were more often seen in the TF group. At multivariate analysis, femoral access was an independent predictor of AKI (odds ratio 1.654, 95% confidence interval 1.084 to 2.524, p = 0.042). In conclusion, in this database of primary PCI, the risk of AKI was lower with a TR approach, and the TF approach was an independent predictor for the occurrence of this complication.
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Affiliation(s)
- Bernardo Cortese
- Interventional Cardiology, A.O. Fatebenefratelli Milano, Milano, Italy.
| | | | - Rodrigo Sebik
- Interventional Cardiology, A.O. Fatebenefratelli Milano, Milano, Italy
| | | | - Alessandro Alonzo
- Interventional Cardiology, Sant'Andrea Hospital, University La Sapienza, Roma, Italy
| | | | | | - Romano G Seregni
- Interventional Cardiology, A.O. Fatebenefratelli Milano, Milano, Italy
| | - Francesca Giovannelli
- Interventional Cardiology, Sant'Andrea Hospital, University La Sapienza, Roma, Italy
| | | | | | - Andrea Berni
- Interventional Cardiology, Sant'Andrea Hospital, University La Sapienza, Roma, Italy
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