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Frequency and predictors of contrast-induced nephropathy after angioplasty for chronic total occlusions
Pablo Aguiar-Souto1, Giuseppe Ferrante, Francesca Del Furia
1Department of Cardiology, Royal Brompton Hospital, London, UK.
Insights
Contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) is uncommon. This study suggests PCI for CTO can proceed without undue concern for CIN, even with significant contrast use.
Area of Science:
- Cardiology
- Nephrology
Background:
- Contrast-induced nephropathy (CIN) risk after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) is not well-established.
- Understanding CIN incidence and predictors in CTO PCI is crucial for patient management.
Purpose of the Study:
- To determine the incidence of CIN after PCI of CTO.
- To evaluate risk factors for CIN in this patient population.
Main Methods:
- Retrospective analysis of 227 patients undergoing PCI for CTO.
- CIN defined as creatinine increase ≥0.5 mg/dl (CIN(05)) or ≥25% (CIN(25)).
- Patients stratified using the Mehran risk score.
Main Results:
- CIN(25) occurred in 6.16% of patients; CIN(05) in 0.88%.
- No patients experienced severe renal dysfunction requiring dialysis.
- Higher contrast volume in CIN patients was not statistically significant.
Conclusions:
- The incidence of CIN following PCI for CTO was low.
- PCI for CTO can be performed without significant fear of CIN, even with moderate-to-large contrast volumes.
Background:
The incidence and predictors of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) have not been specifically reported.
Methods:
This retrospective analysis included all consecutive patients referred for PCI of CTO between April 2003 and March 2008, with baseline and 24 h postprocedural available creatinine levels. CIN was defined as 24 h postprocedural increase of baseline creatinine levels > or =0.5 mg/dl (CIN(05)) or > or =25% (CIN(25)). Severe renal dysfunction (SRD) was defined as acute renal failure requiring dialysis, or an increase in baseline creatinine levels > or =2.0 mg/dl (SRD(2)) or > or =50% (SRD%). Patients were classified into risk categories for CIN, according to the validated Mehran risk score.
Results:
A total of 227 patients were included, mean age of 64+/-10 years, the majority being at low risk for CIN (55% with < or =5 points in the Mehran score). CIN(25) occurred in 6.16% (14/227) patients and CIN(05) in 0.88% (2/227). The incidence of SRD(2) or SDR% was 0% (0/227) and 0.9% (2/227), respectively, with no patient requiring dialysis. Patients who developed CIN(25) received a higher contrast volume than those who did not (312 ml (210-400) vs 260 ml (200-345), p=0.14), but the difference was not statistically significant.
Conclusions:
In this consecutive cohort of patients, the incidence of CIN following PCI for CTO was low despite the administration of moderate to large volumes of contrast media. Attempts at revascularization of CTO should not be discouraged or be prematurely interrupted because of the fear of CIN.
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