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Impact of Chronic Statin Therapy on Postprocedural Contrast-Induced Nephropathy in Patients Undergoing Non-Emergent
Jake M Chanin1, David C Yang, Muhammad A Haider
1New York Presbyterian Hospital, Weill Cornell Medical College, Greenberg Division of Cardiology, 520 East 70th Street, Starr-434 Pavilion, New York, NY 10021 USA. dnf9001@med.cornell.edu.
Insights
Chronic statin therapy may reduce the risk of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). Further multivariate analysis indicated a significant decrease in CIN incidence among patients on long-term statins before PCI.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Percutaneous coronary intervention (PCI) can lead to kidney function decline.
- Chronic statin therapy has shown promise in preventing contrast-induced nephropathy (CIN).
- The role of statins in preventing CIN specifically in non-emergent PCI settings remains unclear.
Purpose of the Study:
- To investigate the association between chronic statin therapy and the incidence of CIN in patients undergoing non-emergent PCI.
- To identify predictors of CIN in this patient population.
Main Methods:
- Analysis of 1171 patients from the 2004-2005 Cornell Angioplasty Registry.
- Comparison of CIN incidence between patients on chronic statin therapy (≥30 days) and those not on statins.
- Multivariate analysis to adjust for confounding factors.
Main Results:
- The overall incidence of CIN was 4.5%.
- Unadjusted analysis showed no significant difference in CIN rates between statin users (4.2%) and non-users (5.4%).
- Multivariate analysis revealed that chronic statin therapy was associated with a significantly lower incidence of CIN (OR, 0.21; P=.04). Acute heart failure and urgent PCI were independent predictors of CIN.
Conclusions:
- Chronic statin therapy was associated with a reduced likelihood of developing CIN following non-emergent PCI.
- The findings suggest a protective effect of long-term statin use against CIN in this context.
Background:
Following percutaneous coronary intervention (PCI), elevations in serum creatinine level and declines in glomerular filtration rate are common. Prior studies have demonstrated benefit of chronic statin therapy in the prevention of contrast-induced nephropathy (CIN); however, it is unknown whether chronic statin therapy reduces the incidence of CIN in the non-emergent PCI setting.
Methods:
Using the 2004-2005 Cornell Angioplasty Registry, a total of 1171 consecutive patients were selected for analysis. The population was divided into two groups: (1) patients on chronic (≥30 days) statin therapy prior to PCI (n = 874); and (2) patients not on chronic statin therapy (n = 297).
Results:
Patients taking chronic statin therapy were more likely to have diabetes mellitus (35.7% vs 22.6%; P<.001), previous myocardial infarction (36.3% vs 20.5%; P<.001), previous PCI (38.9% vs 16.2%; P<.001), and previous coronary artery bypass graft surgery (19.5% vs 11.4%; P=.01). Statin users were also more likely to be taking long-term aspirin (77.8% vs 59.6%; P<.001) and clopidogrel therapy (29.9% vs 14.1%; P<.001). Baseline serum creatinine levels were comparable between the two groups, as were procedural characteristics. The incidence of CIN following PCI was not significantly different between patients on chronic statin therapy versus those not on chronic statin therapy (4.2% vs 5.4%; P=.42). However, after multivariate adjustment, chronic statin therapy was associated with a lower incidence of CIN (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.05-0.94; P=.04). Acute heart failure on admission and the urgency of the procedure (urgent vs elective PCI) were also independent predictors for developing CIN (OR, 3.04; 95% CI, 1.45-6.66 [P=.01] and OR, 2.80; 95% CI, 1.42-5.55 [P=.01], respectively). Long-term mortality rates were similar between those on chronic statin therapy and those not on statins.
Conclusion:
CIN occurred in 4.5% of patients following non-emergent PCI. Multivariate analysis demonstrated that chronic statin therapy decreased the odds of developing CIN in patients undergoing PCI.
