[Systemic and renal effects of preventing contrast nephrotoxicity with isotonic (0.9%) and hypotonic (0.45%) saline]

Risk factors of contrast-induced nephropathy in patients with STEMI and pump failure undergoing percutaneous coronary intervention

Risk factors associated with the development of contrast-induced nephropathy (CIN) remain poorly defined in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). The present study was designed to assess the association between the Killip grade and the development of CIN in patients with STEMI and pump failure undergoing PCI. Data were retrospectively collected from the records of patients with STEMI and pump failure from the Chinese Society of Cardiology and American Heart Association database. A total of 7,471 patients were analyzed, including 5,521 patients with Killip grade II, 878 with Killip III and 1,072 with Killip IV pump failure. Patients were classified into two groups: Those undergoing primary PCI (PPCI; n=5,063) and those undergoing elective PCI (EPCI; n=2,408). Patients in the PPCI group had higher cardiac arrest rates, lower blood pressure and higher cholesterol levels as compared to the EPCI group. There was a statistically significant difference in the rates of CIN with Killip II pump failure in the PPCI group as compared to the EPCI group, but not in those with Killip III and VI pump failure. Logistic regression analysis indicated that the Killip classification is a risk predictor for post-PCI CIN. The present results indicated a positive association between the Killip grade and post-PCI CIN in patients with STEMI and pump failure. In addition, patients with STEMI and Killip grade II pump failure were at a higher risk of PCI after PPCI as compared to EPCI. Further prospective studies are required to confirm the present results.