A correlation between acute kidney injury and myonecrosis after scheduled percutaneous coronary intervention

Association Between Contrast Volume-to-Creatinine Clearance Ratio and the Risk of Perioperative Myocardial Infarction After Elective Percutaneous Coronary Intervention

Although the use of iodinated contrast for percutaneous coronary intervention (PCI) has known toxicity issues, the association between the contrast volume-to-creatinine clearance (V/CrCl) ratio and perioperative myocardial infarction (PMI) is unclear. The present study is aimed to investigate the predictive value of V/CrCl ratio on the incidence of PMI, and to determine a relatively safe contrast media V/CrCl ratio cut-off value to prevent PMI undergoing elective PCI. The V/CrCl ratio were obtained from 5970 patients undergoing elective PCI for single-vessel lesions. Cardiac troponin I (cTnI) were measured at baseline, 8, 16, and 24 hours after PCI. PMI was defined as postprocedural > 5 × upper limit of normal. Receiver operating characteristic (ROC) curves were performed to identify the optimal sensitivity for the V/CrCl range. Multivariate regression model were used to assess the association between V/CrCl ratios and PMI. Eight hundred and ninety-seven patients (15.0%) developed PMI. There was a significant association between higher V/CrCl ratio and the development of PMI (P < 0.001 for the trend). ROC curve analysis indicated that V/CrCl ratio of 2.05 was a discriminator for PMI (area under the curve = 0.674). After adjusting for other potential risk factors, V/CrCl ratio > 2.05 remained significant associated with PMI (odds ratio, 1.921; 95% confidence interval, 1.311-2.815; P = 0.001). The finding of this study suggests the importance of minimizing the contrast media dose to avoid PMI development. Use of a contrast media dose based on renal function with a V/CrCl value < 2.05 might be valuable in preventing PMI.

Microalbuminuria in patients with preserved renal function as a risk factor for contrast-Induced acute kidney injury following invasive coronary angiography

OBJECTIVES

To investigate the association between pre-existing microalbuminuria among patients with preserved renal function and contrast- induced acute kidney injury (AKI) following coronary angiography.

MATERIAL AND METHODS

612 consecutive patients with preserved renal function (eGFR≥60ml/min and without macroalbuminuria) undergoing scheduled coronary angiography were stratified into microalbuminuria group (107 patients) and normal-albuminuria group (505 patients) according to the urine albumin to creatinine ratio (ACR) levels. Microalbuminuria was defined as ACR in the range of 30-300mg/g and normal-albuminuria was defined as ACR<30mg/g. Contrast-induced AKI was defined as a relative increase in serum creatinine (SCr) concentration of at least 25% or an absolute increase in SCr of 44.2μmol/L within 72h after the procedure.

RESULTS

The peak increases of SCr in microalbuminuria group were larger than those in normal-albuminuria group (10.6±12.4μmol/L vs. 4.8±8.9μmol/L，P<0.001). The incidence of AKI was higher in patients with microalbuminuria than those with normal-albuminuria (12.1% vs. 5.0%, P=0.005). Multivariate analysis revealed that there was an association between microalbuminuria and contrast-induced AKI risk after adjusting for confounders.

CONCLUSION

Pre-existing microalbuminuria is associated with greater risk for AKI in patients with a preserved renal function who undergo scheduled coronary angiography.