Association between Serum Ferritin and Contrast-Induced Nephropathy in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Association between Systolic Pulmonary Artery Pressure and Contrast-Induced Nephropathy in Patients with ST-Segment Elevation Myocardial Infarction

Introduction

The objective of this study was to examine whether there is an elevated risk of developing contrast induced nephropathy (CIN) in patients with high systolic pulmonary artery pressure (SPAP) in ST-segment elevation myocardial infarction (STEMI).

Methods

A total of 213 patients diagnosed with STEMI and who underwent primary percutaneous coronary intervention were enrolled in the study. The patients were stratified into two groups based on the presence of CIN. Comparisons between these groups included an assessment of demographic characteristics, laboratory findings, and risk factors. SPAP was calculated for each patient upon admission through echocardiography, and subsequent comparisons were performed between the groups.

Results

The distribution of the study population was as follows: 33 (15.5%) were CIN(+) and 180 (84.5%) were CIN(-). SPAP [odds ratio (OR) = 1.295, 95% confidence interval (CI): 1.157-1.451, p < 0.001], and diabetes (OR = 1.241, 95% CI: 1.194-1.287, p = 0.013) were identified as independent factors associated with CIN development. In receiver operating characteristic curve analysis, SPAP above a cut-off level of 31.5 mmHg could determine the presence of CIN with a sensitivity of 91.0% and specificity of 90.0% (p < 0.001).

Conclusions

SPAP on echocardiography is an independent predictor of the development of CIN in patients with STEMI. Its ease of calculation renders it a valuable tool for predicting CIN among STEMI patients.

Glycemic variability as predictor of contrast-induced nephropathy in diabetic patients with acute myocardial infarction undergoing percutaneous coronary intervention

Background

Contrast-induced nephropathy (CIN) is a frequent complication in patients undergoing percutaneous coronary intervention (PCI). Diabetes mellitus (DM) and acute myocardial infarction (AMI) are associated with an increased risk of CIN. However, it remains unclear whether glycemic variability (GV) has the important prognostic significance of CIN in diabetic patients with AMI undergoing PCI. We conducted this study to investigate the independent prognostic value of the in-hospital GV in diabetic patients who presented with AMI and were treated with PCI.

Methods

The study group comprised 252 diabetic patients with AMI who underwent PCI and were assigned to CINand non-CIN groups. A continuous glucose monitoring system (CGMS) was used to determine the mean amplitude of glycemic excursion (MAGE), a representative index of GV. Independent risk factors for CIN were determined by multivariate logistic regression analysis (MLRA), and receiver-operating characteristic (ROC) analysis was used to measure the prognostic potential of GV.

Results

A total of 55 patients had CIN and they showed markedly elevated MAGE compared with the non-CIN group. MLRA revealed that MAGE had potential to independently predict CIN. The area under the ROC curve, optimal cut-point value, sensitivity and specificity for MAGE were 0.739, 2.95, 70.91% and 61.42%, respectively.

Conclusions

In diabetic AMI patients undergoing PCI, high GV is associated with increased risk of CIN.

Prevalence and Predictors of Contrast-Induced Nephropathy (CIN) in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Percutaneous Coronary Intervention (PCI): A Meta-Analysis

Background

Contrast-induced nephropathy (CIN) becomes more and more frequent after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). There have been no reported meta-analyses to determine the role of these risk factors in predicting CIN in patients with STEMI undergoing PCI. So we made this meta-analysis to summarize the incidence of CIN in patients with STEMI undergoing PCI and to study associations between CIN and several risk factors that are mentioned in most prevention guidelines.

Hypothesis

The overall incidence of CIN in patients with STEMI undergoing PCI is not low. Many risk factors could influence the occurrence of CIN, such as hypertension, diabetes mellitus (DM), and lower estimated glomerular filtration rate.

Methods

Databases, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Chinese BioMedical (CBM), were searched for articles published before May 21, 2019, to identify all relevant studies on CIN. The pooled data were analyzed using either fixed-effects or random-effects models depending on heterogeneity (assessed via the I ² index).

Results

Twelve articles encompassing a total of 6342 patients were included. The overall pooled CIN incidence was 13.3% (95% CI: 10.4-17.1). The forest plots showed positive associations between CIN and the presence of hypertension, diabetes mellitus, history of prior myocardial infarction, age, damaged left anterior descending artery, Killip class ≥2, decreased left ventricular ejection fraction, lower estimated glomerular filtration rate, and left ventricular ejection fraction <40%; the odds ratios for these factors were 1.85 (95% CI: 1.57-2.18; p < 0.00001), 1.83 (95% CI: 1.47-2.29; p < 0.00001), 2.14 (95% CI: 1.46-3.14; p < 0.0001), 7.79 (95% CI: 5.24-10.34; p < 0.00001), 1.92 (95% CI: 1.15-3.22; p=0.01), 3.12 (95% CI: 2.21-4.40; p < 0.00001), -6.15 (95% CI: -9.52 to -2.79; p=0.0003), -15.06 (95% CI: -24.75 to -5.36; p=0.002), and 5.53 (95% CI: 1.10-27.95; p=0.04), respectively.

Conclusion

The overall incidence of CIN in patients with STEMI undergoing PCI was not low and was closely associated with hypertension, diabetes mellitus, history of prior myocardial infarction, age, damaged left anterior descending artery, Killip class ≥2, decreased left ventricular ejection fraction, lower estimated glomerular filtration rate, and left ventricular ejection fraction <40%.

Effects of Serum Cytochrome c on Contrast-Induced Nephropathy in Patients with ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Background and Aims

Contrast-induced nephropathy (CIN) is a relatively infrequent complication after percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). However, little is known about the association between cytochrome c (cyt c) and increased risk of CIN. We conducted this study to explore the impact of serum cyt c on the occurrence of CIN.

Methods

We prospectively examined cyt c levels before undergoing PCI in 240 patients with STEMI. The logistic regression was performed to identify the independent risk factors for the occurrence of CIN. The receiver operating characteristic (ROC) analysis was employed to evaluate the predictive value of cyt c for the occurrence of CIN.

Results

29 patients (12.1%) had developed CIN after the PCI procedure. The cyt c levels at baseline were significantly higher in patients who developed CIN than those in non-CIN group (0.65±0.08 versus 0.58±0.1; P = 0.001). The multivariate logistic regression showed that cyt c was an independent risk factor for the occurrence of CIN (OR, 7.421; 95% CI, 6.471–20.741; P = 0.034) after adjusting for age, history of hypertension and diabetes mellitus, levels of creatinine, uric acid, and glucose. The ROC curve analysis showed that the area under the curve of cyt c was 0.697 (95% CI, 0.611–0.783; P = 0.001), and cyt c > 0.605 ng/mL predicted CIN with sensitivity of 79.3% and specificity of 56.9%.

Conclusion

Our results show that a higher cyt c level was significantly associated with the occurrence of CIN after PCI in STEMI patients. This study has been registered in the Chinese Clinical Trial Registry. The clinical trial registration number is ChiCTR1800019368.