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Acute hyperglycemia and contrast-induced nephropathy in primary percutaneous coronary intervention

Giancarlo Marenzi1, Monica De Metrio, Mara Rubino

  • 1Department of Cardiovascular Sciences, Centro Cardiologico Monzino, I.R.C.C.S, University of Milan, Milan, Italy. giancarlo.marenzi@ccfm.it

American Heart Journal
|December 15, 2010
PubMed

Insights

Acute hyperglycemia in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) significantly increases the risk of contrast-induced nephropathy (CIN) and in-hospital mortality.

Area of Science:

  • Cardiology
  • Nephrology
  • Critical Care Medicine

Background:

  • Acute hyperglycemia and contrast-induced nephropathy (CIN) are common in ST-elevation acute myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
  • Both conditions are linked to higher mortality rates.
  • This study explores the relationship between acute hyperglycemia and CIN in this patient population.

Purpose of the Study:

  • To investigate the association between acute hyperglycemia and the development of contrast-induced nephropathy (CIN).
  • To assess the impact of acute hyperglycemia and CIN on in-hospital mortality in STEMI patients undergoing primary PCI.

Main Methods:

  • Prospective enrollment of 780 STEMI patients undergoing primary PCI.
  • Plasma glucose levels measured on admission; acute hyperglycemia defined as >198 mg/dL.
  • CIN defined as a serum creatinine increase >25% within 72 hours.

Main Results:

  • 19% of patients had acute hyperglycemia, and 14.5% developed CIN.
  • Acute hyperglycemia was associated with a 2-fold higher incidence of CIN (27% vs 12%).
  • Patients with acute hyperglycemia and those with CIN had significantly higher in-hospital mortality rates (12% vs 3% and 27% vs 0.9%, respectively).
  • Acute hyperglycemia independently predicted both CIN and in-hospital mortality.

Conclusions:

  • Acute hyperglycemia is a significant risk factor for CIN in STEMI patients undergoing primary PCI.
  • Acute hyperglycemia is associated with increased in-hospital mortality in this patient group.
  • The combination of acute hyperglycemia and CIN presents the highest mortality risk.
Abstract

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