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Female gender and contrast-induced nephropathy in primary percutaneous intervention for ST-segment elevation
Stefano Lucreziotti1, Marco Centola1, Diego Salerno-Uriarte1
1Cardiologia, Ospedale San Paolo, Dipartimento di Scienze della Salute, University of Milan, Italy.
Insights
Female patients undergoing primary percutaneous coronary intervention (PCI) face a higher risk of contrast-induced nephropathy (CIN). Lower ejection fraction and female gender predict CIN, while CIN and Mehran Risk Score predict mortality.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Contrast-induced nephropathy (CIN) is a significant risk following primary percutaneous coronary intervention (PCI).
- Female patients may experience higher rates of CIN and mortality post-PCI, but the role of gender is complex.
- Understanding predictors of CIN and mortality is crucial for patient outcomes.
Purpose of the Study:
- To investigate the relationship between patient variables, including gender, and the incidence of CIN.
- To identify predictors of long-term mortality after primary PCI.
- To clarify the specific role of female gender in CIN development and outcomes.
Main Methods:
- A single-center study involving 323 consecutive patients undergoing primary PCI.
- CIN was defined as an increase in serum creatinine (≥25% or ≥0.5 mg/dl) within 3 days post-procedure.
- An 18-month median follow-up was used to assess mortality.
Main Results:
- CIN occurred in 25.0% of females versus 11.2% of males (p=0.003).
- Reduced left ventricular ejection fraction (LVEF) and female gender independently predicted CIN.
- CIN development and a Mehran Risk Score (MRS) ≥6 independently predicted long-term mortality.
Conclusions:
- Female gender and reduced LVEF are associated with increased CIN risk after primary PCI.
- The Mehran Risk Score and the development of CIN are predictors of long-term mortality.
- These findings highlight key factors for risk stratification and management in patients undergoing primary PCI.
Background:
Patients undergoing primary percutaneous coronary intervention (PCI) are at high risk for contrast-induced nephropathy (CIN), a complication that has been demonstrated to negatively affect outcomes. It has been suggested that, when compared to males, female patients present higher incidence of CIN and higher mortality after primary PCI. However, the specific role of gender in this setting remains ill-defined given its complex interplay with several co-morbidities and clinical characteristics. We investigated the relationship of patients' variables, including gender, with CIN and mortality after primary PCI.
Methods:
In a single center study in 323 consecutive patients undergoing primary PCI, the development of CIN and mortality during an 18-month median follow-up period was assessed. CIN was defined as an increase in serum creatinine (≥25% or ≥0.5 mg/dl) from baseline occurring at any time during the first 3 post-procedural days.
Results:
CIN occurred in 23 female and 26 male patients (25.0% vs 11.2%, p=0.003), while cumulative mortality was 10.6%. Women presented unfavorable basal characteristics and underwent myocardial reperfusion less quickly. At multivariable analysis, reduced left ventricular ejection fraction (LVEF) (odds ratio [OR] 7.32 95% confidence interval [CI]: 2.60-21, p<0.001) and female gender (OR 2.49 95%CI 1.22-5.07, p=0.01) predicted CIN, whereas the occurrence of CIN (hazard ratio [HR] 3.65 95%CI 1.55-8.59, p=0.003) and a Mehran risk score (MRS)≥6 (HR 1.76 95%CI 1.13-2.74, p=0.01) independently predicted long-term mortality.
Conclusions:
After primary PCI, female gender and LVEF are associated with an increased risk of CIN, whereas MRS and development of CIN predict long-term mortality.
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