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Acute Kidney Injury After Primary Angioplasty: Is Contrast-Induced Nephropathy the Culprit?
Oren Caspi1,2, Manhal Habib1,2, Yuval Cohen1,2
1Department of Cardiology, Rambam Medical Center, Haifa, Israel.
Journal of the American Heart Association
|June 26, 2017
Summary
Contrast material exposure does not increase the risk of acute kidney injury (AKI) following primary percutaneous coronary intervention (pPCI). AKI in ST-segment-elevation myocardial infarction patients is primarily linked to factors like age, heart failure, and hemodynamic instability.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Acute kidney injury (AKI) after primary percutaneous coronary intervention (pPCI) is often attributed to contrast media.
- Alternative causes of AKI in ST-segment-elevation myocardial infarction (STEMI) patients undergoing pPCI require investigation.
Purpose of the Study:
- To investigate the causal association between contrast material exposure and AKI incidence in STEMI patients undergoing pPCI.
- To compare AKI rates in patients who received pPCI with contrast material versus a control group without contrast exposure.
Main Methods:
- A cohort of 2025 STEMI patients undergoing pPCI was compared to 1025 patients receiving fibrinolysis or no reperfusion (control group).
- Propensity score matching was used to create a balanced cohort of 931 pairs of patients with and without PCI.
- AKI was defined by creatinine levels or percentage rise within 72 hours.
Main Results:
- Overall AKI rates were similar between the pPCI (10.3%) and control (12.1%) groups (P=0.38).
- In propensity score-matched cohorts, AKI rates did not differ significantly between PCI (8.6%) and no PCI (10.9%) groups (P=0.12).
- Independent AKI predictors in the pPCI cohort included age, diabetes, diuretic use, anterior infarction, baseline kidney function, and heart failure indicators, but not contrast dose.
Conclusions:
- AKI development in STEMI patients undergoing pPCI is primarily associated with patient factors like age, baseline kidney function, heart failure, and hemodynamic instability.
- Contrast material exposure is not a significant independent risk factor for AKI in this patient population.
- The risk of AKI is comparable between STEMI patients undergoing pPCI and those treated without contrast material.
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