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Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction
Giancarlo Marenzi1, Gianfranco Lauri, Emilio Assanelli
1Centro Cardiologico Monzino, I.R.C.C.S., Institute of Cardiology of the University of Milan, Milan, Italy. giancarlo.marenzi@ccfm.it
Insights
Contrast-induced nephropathy (CIN) affects 19% of patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). CIN significantly increases hospital stay and mortality, highlighting the need for preventive strategies in high-risk individuals.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Contrast-induced nephropathy (CIN) is a known complication following percutaneous coronary intervention (PCI).
- Patients with acute myocardial infarction (AMI) undergoing primary PCI are at increased risk due to potential hemodynamic instability and challenges with prophylactic measures.
Purpose of the Study:
- To determine the incidence of CIN after primary PCI in AMI patients.
- To identify clinical predictors associated with CIN development.
- To evaluate the outcomes of patients who develop CIN post-primary PCI.
Main Methods:
- Serum creatinine levels were monitored daily for three days in 208 consecutive AMI patients undergoing primary PCI.
- CIN was defined as an increase in serum creatinine concentration greater than 0.5 mg/dl.
- Multivariate analysis was used to identify independent predictors of CIN.
Main Results:
- The overall incidence of CIN was 19% (40 patients).
- Patients with baseline creatinine clearance <60 ml/min had a significantly higher incidence of CIN (40%) compared to those with clearance ≥60 ml/min (13%).
- Independent predictors of CIN included age >75 years, anterior infarction, time-to-reperfusion >6 hours, contrast volume >300 ml, and intra-aortic balloon use. Patients with CIN experienced longer hospital stays (13 vs. 8 days) and a markedly higher mortality rate (31% vs. 0.6%).
Conclusions:
- CIN is a frequent complication after primary PCI for AMI, even in patients with normal renal function.
- CIN is associated with increased in-hospital complications and significantly higher mortality.
- Preventive strategies are crucial, especially for high-risk patient populations undergoing primary PCI.
Objectives:
The aim of this research was to assess the incidence, clinical predictors, and outcome of contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).
Background:
Contrast-induced nephropathy is associated with significant morbidity and mortality after PCI. Patients undergoing primary PCI may be at higher risk of CIN because of hemodynamic instability and unfeasibility of adequate prophylaxis.
Methods:
In 208 consecutive AMI patients undergoing primary PCI, we measured serum creatinine concentration (Cr) at baseline and each day for the following three days. Contrast-induced nephropathy was defined as a rise in Cr >0.5 mg/dl.
Results:
Overall, CIN occurred in 40 (19%) patients. Of the 160 patients with baseline Cr clearance >/=60 ml/min, only 21 (13%) developed CIN, whereas it occurred in 19 (40%) of those with Cr clearance <60 ml/min (p < 0.0001). In multivariate analysis, age >75 years (odds ratio [OR] 5.28, 95% confidence interval [CI] 1.98 to 14.05; p = 0.0009), anterior infarction (OR 2.17, 95% CI 0.88 to 5.34; p = 0.09), time-to-reperfusion >6 h (OR 2.51, 95% CI 1.01 to 6.16; p = 0.04), contrast agent volume >300 ml (OR 2.80, 95% CI 1.17 to 6.68; p = 0.02) and use of intraaortic balloon (OR 15.51, 95% CI 4.65 to 51.64; p < 0.0001) were independent correlates of CIN. Patients developing CIN had longer hospital stay (13 +/- 7 days vs. 8 +/- 3 days; p < 0.001), more complicated clinical course, and significantly higher mortality rate (31% vs. 0.6%; p < 0.001).
Conclusions:
Contrast-induced nephropathy frequently complicates primary PCI, even in patients with normal renal function. It is associated with higher in-hospital complication rate and mortality. Thus, preventive strategies are needed, particularly in high-risk patients.
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