The impact of iso-osmolar contrast use in emergent percutaneous coronary intervention for ST-segment elevation...

Area of Science:

• Cardiology
• Nephrology
• Interventional Cardiology

Background:

• Contrast-induced nephropathy (CIN) is a significant risk in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
• Previous studies suggested iso-osmolar contrast agents may reduce CIN risk in high-risk populations, but recent meta-analyses showed no significant benefit.
• Emergent PCI for STEMI involves unique patient profiles and procedural considerations that warrant further investigation into contrast agent efficacy.

Purpose of the Study:

• To evaluate the impact of iso-osmolar contrast media on the incidence of CIN in patients undergoing emergent PCI for STEMI.
• To identify predictors of CIN in this specific patient cohort.

Main Methods:

• Retrospective analysis of 212 patients undergoing primary or rescue PCI for STEMI.
• Patients received either low-osmolar or iso-osmolar contrast agents at the operator's discretion.
• CIN defined as a creatinine increase >0.5 mg/dL or 25% within 72 hours.

Main Results:

• The overall incidence of CIN was 16% (33 out of 212 patients).
• No significant difference in CIN incidence was observed between low-osmolar (14%) and iso-osmolar (17%) contrast groups (P=.799).
• Lower ejection fraction, post-PCI TIMI flow <3, and lower hemoglobin levels were independently associated with higher CIN incidence.

Conclusions:

• The use of iso-osmolar contrast agents was not associated with a reduced incidence of CIN in patients undergoing emergent PCI for STEMI.
• CIN risk in STEMI patients undergoing PCI is multifactorial, influenced by cardiac function, reperfusion success, and hematological status.