Role of hydration in contrast-induced nephropathy in patients who underwent primary percutaneous coronary...

Area of Science:

• Cardiology
• Nephrology
• Interventional Cardiology

Background:

• Contrast-induced nephropathy (CIN) is a significant complication in patients with ST-segment elevation myocardial infarction (STEMI).
• Primary percutaneous coronary intervention (PPCI) is a standard treatment for STEMI, often involving iodinated contrast media.
• Preventive strategies for CIN are crucial, especially in high-risk emergent procedures.

Purpose of the Study:

• To evaluate the efficacy of intravenous saline hydration in preventing CIN.
• To assess the impact of CIN on mortality and the need for dialysis in STEMI patients undergoing PPCI.

Main Methods:

• A prospective study involving 408 STEMI patients undergoing PPCI.
• Patients were randomized to receive either isotonic saline hydration (NS+ group) or no hydration (NS- group).
• CIN was defined as a ≥25% or ≥0.5 mg/dl increase in serum creatinine within 3 days post-procedure.

Main Results:

• CIN incidence was 11% in the NS+ group versus 21% in the NS- group (p=0.016), a 48% risk reduction.
• CIN was significantly associated with increased mortality (15.2% vs 2.8%; p<0.0001) and need for dialysis (13.4% vs 0%; p<0.0001).
• Multivariate analysis identified hydration (OR=0.29) and pre-procedure hemoglobin (OR=0.69) as key predictors of CIN.

Conclusions:

• Intravenous saline hydration significantly reduces the incidence of CIN in STEMI patients undergoing PPCI.
• CIN is a strong predictor of adverse outcomes, including death and dialysis.
• Preventive hydration should be considered a standard, mandatory measure in emergent PPCI procedures unless contraindicated.