Contrast medium induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary
Ingo Wickenbrock1, Christian Perings, Petra Maagh
1Department of Cardiology and Pneumology, St. Marien Hospital Lünen, Academic Teaching Hospital of the University of Münster, Lünen, Germany. wickenbrock.ingo@smh-online.de
Insights
Contrast medium induced nephropathy (CIN) occurred in 11.5% of patients after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). CIN was linked to increased complications and mortality, necessitating improved preventive strategies.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Contrast medium induced nephropathy (CIN) increases morbidity and mortality post-coronary intervention.
- Patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) have a higher risk of CIN.
- Non-ST-elevating myocardial infarction (NSTEMI) patients may be at higher risk for CIN than ST-elevating myocardial infarction (STEMI) patients due to older age and higher diabetes prevalence.
Purpose of the Study:
- To assess the incidence of CIN in patients undergoing PCI for acute coronary syndrome (ACS).
- To identify clinical predictors of CIN development.
- To evaluate the outcome of patients who develop CIN after PCI for ACS.
Main Methods:
- A prospective study included 392 consecutive ACS patients undergoing emergent coronary angiography.
- Serum creatinine levels were measured at baseline and for three days post-procedure.
- CIN was defined as a serum creatinine increase > 0.5 mg/dl.
Main Results:
- Overall, 11.5% of patients developed CIN (10.8% in STEMI vs. 12.2% in NSTEMI, P=0.75).
- Patients who developed CIN had a more complicated clinical course, longer hospital stay (14 vs. 10 days), and significantly higher mortality (16% vs. 6%).
- While STEMI patients required more contrast medium, CIN incidence did not differ significantly between STEMI and NSTEMI groups.
Conclusions:
- No significant difference in CIN incidence was observed between STEMI and NSTEMI patients undergoing PCI.
- Predisposing factors for CIN differed significantly between STEMI and NSTEMI groups.
- CIN is associated with increased in-hospital complications and mortality, highlighting the need for tailored preventive strategies.
Unlabelled:
The aim of this study was to assess the incidence, clinical predictors, and outcome of patients developing contrast medium induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS).
Background:
CIN is associated with significant higher morbidity and mortality after coronary intervention. Recently it was shown, that patients undergoing percutaneous coronary intervention for acute myocardial infarction have a significant higher risk of developing CIN. Non-ST-elevating myocardial infarction (NSTEMI) patients (pts) might be at an even higher risk developing CIN than patients with ST-elevating myocardial infarction (STEMI), because of presenting older and more often with diabetes.
Methods:
In 392 consecutive ACS patients developing myocardial infarction and therefore undergoing emergent coronary angiography between October 2004 and March 2007, we measured serum creatinine concentration (Cr) at baseline and each day of the following 3 days. Contrast medium induced nephropathy was defined as an increase in Cr > 0.5 mg/dl. ACS was defined according to the guidelines of the German Society of Cardiology.
Results:
Overall, 392 pts were included: 203 (51.8%) with STEMI and 189 (48.2%) with NSTEMI. Patients with STEMI developed more often a cardiogenic shock (18 vs. 6%; P < 0.001) whereas patients with NSTEMI were older (67 vs. 61 years; P < 0.001) and presenting with a higher co-morbidity. Forty-five (11.5%) pts developed CIN; 22 (10.8%) in the STEMI group and 23(12.2%) in the NSTEMI group (P = 0.75). Patients developing CIN presented a more complicated clinical course and a significantly longer hospital stay (14 vs. 10 days; P < 0.001). The mortality rate was also significantly higher (16 vs. 6%; P < 0.05).
Conclusion:
This prospective study showed no differences in the incidence of developing CIN in patients undergoing PCI for STEMI or NSTEMI, but the predisposing factors, however, differed significantly. Although STEMI patients needed significantly more contrast medium for revascularisation, they did not develop CIN more often. CIN was associated with higher in-hospital complication rate and mortality. Thus, better preventive strategies according to the different predisposing factors leading to CIN are needed to reduce morbidity and mortality, especially in high risk patients.
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