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Impact of an Early Decrease in Systolic Blood Pressure on The Risk of Contrast-Induced Nephropathy after Percutaneous
Hualong Li1, Shuijin Huang2, Yiting He3
1Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
Insights
A drop in systolic blood pressure after procedures may signal a higher risk of contrast-induced nephropathy (CIN). Monitoring postprocedural blood pressure is crucial for patient care.
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- The period after procedures involving contrast media was considered critical for kidney injury.
- Rapid contrast excretion was thought to cause renal hypoperfusion, increasing the risk of contrast-induced nephropathy (CIN).
Purpose of the Study:
- To investigate the association between early postprocedural systolic blood pressure (SBP) decrease and the risk of CIN.
- To identify SBP decrease as a potential predictor for CIN in patients undergoing percutaneous coronary intervention (PCI).
Main Methods:
- A study included 349 patients undergoing procedures.
- Multivariate logistic regression was used to assess the relationship between postprocedural SBP decrease and CIN risk.
Main Results:
- A postprocedural SBP decrease occurred in 63% of patients; 8.0% developed CIN.
- Patients who developed CIN had lower postprocedural SBP and a greater SBP decrease (>10mmHg).
- A postprocedural SBP decrease >10mmHg was an independent predictor of CIN (OR 2.368, P=0.039).
Conclusions:
- An early, moderate decrease in postprocedural SBP may elevate the risk of CIN.
- This finding highlights the importance of monitoring SBP in the immediate post-procedure period.
Background:
The early postprocedural period was thought to be the rush hour of contrast media excretion, causing rapid and prolonged renal hypoperfusion, which was the critical time window for contrast-induced nephropathy (CIN).
Methods:
349 consecutive patients were enrolled into the study. The relation between an early postprocedural decrease in systolic blood pressure (SBP) and the risk of CIN was assessed using multivariate logistic regression.
Results:
A postprocedural decrease in SBP was observed in 63% of patients and CIN developed in 28 (8.0%) patients. The CIN group had a lower postprocedural SBP (114.5±13.5 vs. 123.7±15.6mmHg, P=0.003) and a greater postprocedural decrease in SBP (16.2±19.1 vs. 5.9±18.7mmHg, P=0.005) than the no-CIN group. ROC analysis revealed that the optimum cutoff value for the SBP decrease in detecting CIN was >10mmHg (sensitivity 60.7%, specificity 59.5%, AUC=0.66). Multivariate logistic regression analysis found that a postprocedural decrease in SBP >10mmHg was a significant independent predictor of CIN (OR 2.368, 95%CI: 1.043-5.379, P=0.039), after adjustment for other risk factors.
Conclusion:
An early moderate postprocedural decrease in SBP may increase the risk of CIN in patients undergoing PCI.
