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Multivessel Revascularization Does Not Increase Contrast-Induced Acute Kidney Injury Incidence in Acute Myocardial
Bertrand N Mukete1, Russell A Riehl2, Alvaro Alonso1
1Division of Cardiology, Department of Medicine, Tulane University School of Medicine, Heart and Vascular Institute, 1430 Tulane Avenue, SL-48, New Orleans, LA, 70112, USA.
Insights
Complete revascularization (CR) in ST-segment elevation myocardial infarction (STEMI) reduces cardiac death and revascularization needs. This strategy, despite increased contrast use, showed a non-significant trend toward reduced contrast-induced acute kidney injury (CI-AKI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Nephrology
Background:
- Complete revascularization (CR) in ST-segment elevation myocardial infarction (STEMI) is linked to lower mortality compared to infarct-related artery revascularization (IRA).
- The association between CR versus IRA and contrast-induced acute kidney injury (CI-AKI) during the index hospitalization remains unclear.
Purpose of the Study:
- To evaluate the risk of CI-AKI in STEMI patients undergoing CR versus IRA during their initial hospitalization.
- To compare other adverse outcomes, including mortality, bleeding, and stroke, between CR and IRA strategies.
Main Methods:
- A systematic search of randomized controlled trials comparing CR versus IRA in STEMI patients who reported CI-AKI.
- Meta-analysis using Comprehensive Meta-Analysis software with a fixed-effect model to calculate summary risk ratios and 95% confidence intervals.
Main Results:
- Four trials with 1537 patients were analyzed. CR groups used significantly more contrast (276.7 mL vs. 186.7 mL).
- No significant difference in CI-AKI incidence (1.3% CR vs. 1.9% IRA; p=0.4) was observed.
- CR was associated with significantly reduced cardiovascular death (2.0% vs. 4.7%; p=0.01) and ischemia-driven revascularization (6.2% vs. 18.3%; p<0.01).
Conclusions:
- Complete revascularization in STEMI patients significantly reduces the risk of cardiac death and revascularization.
- CR demonstrates a non-significant trend towards reduced CI-AKI, even with increased contrast administration.
- CR is a favorable strategy in STEMI, offering survival benefits without increasing CI-AKI risk.
Background:
Recent studies and meta-analysis have shown that complete revascularization (CR) compared with infarct-related artery revascularization (IRA) during percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) is associated with decreased mortality. However, it is unclear if CR versus IRA in STEMI during indexed hospitalization is associated with risk of contrast-induced acute kidney injury (CI-AKI).
Methods:
A database search was conducted for all randomized controlled trials that enrolled STEMI patients and compared CR versus IRA and reported CI-AKI. Comprehensive Meta-Analysis Version 2.0 (Wiley, Chichester) was used to determine summary effect size with a fixed-effect model and expressed as a risk ratio with 95 % confidence intervals.
Results:
A total of four trials were identified and had a mean follow-up of 24.5 ± 9.9 months, a total sample size of 1537, a mean age of 63.8 ± 1.2 versus 64.2 ± 2.1 years, 31.2 ± 5.3 versus 30.1 ± 4.7 % three-vessel disease, and 33.7 ± 4.1 versus 37.2 ± 4.5 % anterior STEMI in the CR versus IRA groups, respectively. A total of 276.7 ± 25.2 versus 186.7 ± 15.3 mL contrast was used in the CR versus IRA respectively (p = 0.006). There were no statistical significant differences between the two groups in the reported incidence of CI-AKI (1.3 % CR vs. 1.9 % IRA; p = 0.4), major bleeding (1.7 % CR vs. 2.5 % IRA; p = 0.4) and stroke (1.1 % CR vs. 0.4 % IRA; p = 0.24). However, there was a significantly increased incidence of cardiovascular death (2.0 % CR vs. 4.7 % IRA; p = 0.01) and ischemia-driven revascularization (6.2 % CR vs. 18.3 % IRA; p < 0.01).
Conclusion:
In the index hospitalization, CR in STEMI patients is associated with significant risk reduction in cardiac death and revascularization and a non-significant reduced trend of CI-AKI, despite increased use of contrast when compared with IRA.
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