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Published on: May 28, 2019
Contrast-induced nephropathy after primary angioplasty for acute myocardial infarction
Paulo Roberto Santos1, Joaquim David Carneiro Neto1, Francisco Plácido Nogueira Arcanjo1
1Universidade Federal do Ceará, Brazil.
Insights
Contrast-induced nephropathy (CIN) affects nearly a quarter of patients undergoing emergency angioplasty for myocardial infarction (MI). No independent predictors were identified, emphasizing the need for preventive strategies.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Preventing contrast-induced nephropathy (CIN) is challenging in emergency settings.
- Urgent angioplasty for myocardial infarction (MI) necessitates studying CIN incidence and risk factors.
Purpose of the Study:
- To determine the incidence of CIN in patients with ST-elevation MI undergoing primary angioplasty within 12 hours of symptom onset.
- To identify factors associated with CIN in this high-risk patient population.
Main Methods:
- A consecutive series of 201 patients with ST-elevation MI within 12 hours of symptom onset were analyzed.
- CIN was defined as a creatinine increase of ≥0.5 mg/dL or ≥25% within 48-72 hours post-contrast.
- Univariate and logistic regression analyses were used to identify associated factors.
Main Results:
- The study included 201 patients (67.2% men, mean age 66.6 years).
- The incidence of CIN was 23.8%.
- Univariate analysis showed older age, reduced left ventricular ejection fraction (≤40%), and higher Killip classification (≥2) were associated with CIN; however, multivariate analysis found no independent predictors.
Conclusions:
- CIN occurred in 23.8% of patients undergoing emergency angioplasty for MI.
- The absence of identified independent predictors underscores the importance of implementing preventive measures for CIN in all patients receiving contrast during emergency angioplasty.
Introduction:
The prevention of contrast-induced nephropathy (CIN) is difficult in emergency situations, making it essential to study CIN in patients submitted to urgent angioplasty.
Objective:
To determine the incidence and associated factors to CIN in patients with myocardial infarction (MI) submitted to primary angioplasty in the first 12 hours after onset of symptoms.
Methods:
We studied 201 consecutive cases of MI with ST-segment elevation with less than 12 hours of evolution. All patients were submitted to the same angioplasty protocol. CIN was defined as an absolute increase of creatinine of at least 0.5 mg/dL and/or a relative increase of creatinine of 25% in relation to baseline in a period between 48 and 72 hours after contrast administration. The variables that differed between patients with and without CIN in univariate analysis were analyzed by logistic regression.
Results:
The sample was formed by 135 (67.2%) men and 66 (32.8%) women, with mean age of 66.6 ± 11.7 years. The incidence of CIN was 23.8%. In univariate analysis the patients with CIN were older and had higher frequency of left ventricular ejection fraction ≤ 40% and Killip classification ≥ 2. In multivariate analysis, we did not find independent predictors of CIN.
Conclusion:
CIN occurred in ¼ of the patients with MI submitted to angioplasty without predictor variables. This finding highlights the need for CIN preventive measures after contrast use in emergency angioplasty.
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