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Risk of contrast-induced acute kidney injury in ST-elevation myocardial infarction patients undergoing multi-vessel

Saurav Chatterjee1, Amartya Kundu2, Debabrata Mukherjee3

  • 1Division of Cardiology, St. Luke's-Roosevelt Hospital Center of the Mount Sinai Health System, New York, New York.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|January 24, 2017
PubMed

Insights

Multi-vessel percutaneous coronary intervention (MV-PCI) in ST-segment elevation myocardial infarction (STEMI) patients does not increase the risk of contrast-induced acute kidney injury (CI-AKI). The Mehran risk score effectively identifies high-risk patients for CI-AKI.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Complete revascularization improves outcomes in ST-elevation myocardial infarction (STEMI) patients with multi-vessel disease.
  • Multi-vessel percutaneous coronary intervention (MV-PCI) may increase the risk of contrast-induced acute kidney injury (CI-AKI).

Purpose of the Study:

  • To evaluate the risk of CI-AKI in STEMI patients undergoing MV-PCI.
  • To assess the accuracy of the Mehran risk score in predicting CI-AKI in MV-PCI patients.

Main Methods:

  • Systematic review of randomized controlled trials comparing MV-PCI with infarct-related artery (IRA)-only PCI.
  • Meta-analysis using a random effects model to estimate risk ratios (RR) and confidence intervals (CI).
  • Analysis of Nationwide Inpatient Sample (NIS) data to evaluate the Mehran risk score's predictive accuracy.

Main Results:

  • Four studies (N=1,602) showed no significant difference in CI-AKI rates between MV-PCI (1.45%) and IRA-only PCI (1.94%) (RR 0.73, 95% CI 0.34-1.57).
  • In a large NIS cohort (11,454 MV-PCI for STEMI patients), the Mehran risk score demonstrated good discrimination for CI-AKI (c-statistic=0.78).

Conclusions:

  • MV-PCI in STEMI patients is not associated with an increased risk of CI-AKI.
  • The Mehran risk score is a valuable tool for identifying STEMI patients undergoing MV-PCI who are at higher risk for CI-AKI.
Abstract

Keywords:
STEMIcontrast-induced acute kidney injurymehran risk scoremultivessel-PCI

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