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Published on: May 28, 2019
Association Between Acidosis Soon After Reperfusion and Contrast-Induced Nephropathy in Patients With a First-Time
Masaomi Gohbara1, Azusa Hayakawa2, Yusuke Akazawa2
1Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan gocchi3@hotmail.com.
Insights
Acidosis after reperfusion is linked to contrast-induced nephropathy (CIN) in ST-elevation myocardial infarction patients. This finding helps identify patients at risk for kidney damage after cardiac procedures.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Contrast-induced nephropathy (CIN) is a significant complication following procedures involving contrast media in acute myocardial infarction (AMI) patients.
- CIN is associated with adverse outcomes, yet its predictors remain incompletely understood, necessitating further investigation.
Purpose of the Study:
- To elucidate the predictors of contrast-induced nephropathy (CIN) in patients experiencing their first ST-segment elevation myocardial infarction (STEMI).
- To investigate the association between acidosis and CIN in this patient population.
Main Methods:
- A cohort of 273 consecutive patients with first-time STEMI undergoing reperfusion within 12 hours were analyzed.
- Exclusion criteria included hemodialysis, mechanical ventilation, or prior coronary artery bypass grafting.
- Arterial blood gas analysis was performed post-reperfusion; CIN was defined by serum creatinine increase, and acidosis by pH <7.35.
Main Results:
- Contrast-induced nephropathy (CIN) occurred in 12.8% of patients.
- Multivariable analysis identified reperfusion time, hypertension, peak creatine kinase-MB, high-sensitivity C-reactive protein, and acidosis as significant CIN predictors.
- Acidosis independently predicted CIN, even after adjusting for established risk factors and the Mehran CIN score (OR: 2.229, P=0.049).
Conclusions:
- Acidosis developing soon after reperfusion is a significant independent predictor of contrast-induced nephropathy (CIN).
- This finding highlights the importance of monitoring acid-base balance post-reperfusion in STEMI patients to mitigate CIN risk.
Background:
Contrast-induced nephropathy (CIN) is associated with poor outcomes in patients with acute myocardial infarction. However, the predictors of CIN have yet to be fully elucidated.
Methods And Results:
The study included 273 consecutive patients with a first-time ST-segment elevation myocardial infarction who underwent reperfusion within 12 hours of symptom onset. The exclusion criteria were hemodialysis, mechanical ventilation, or previous coronary artery bypass grafting. All patients underwent arterial blood gas analysis soon after reperfusion. CIN was defined as an increase of 0.5 mg/dL in serum creatinine or a 25% increase from baseline between 48 and 72 hours after contrast medium exposure. Acidosis was defined as an arterial blood pH <7.35. CIN was observed in 35 patients (12.8%). Multivariable logistic regression analysis with forward stepwise algorithm revealed a significant association between CIN and the following: reperfusion time, the prevalence of hypertension, peak creatine kinase-MB, high-sensitivity C-reactive protein on admission, and the incidence of acidosis (P<0.05). Multivariable logistic regression analysis revealed that the incidence of acidosis was associated with CIN when adjusted for age, male sex, body mass index, amount of contrast medium used, estimated glomerular filtration rate on admission, glucose level on admission, high-sensitivity C-reactive protein on admission, and left ventricular ejection fraction (P<0.05). Moreover, the incidence of acidosis was associated with CIN when adjusted for the Mehran CIN risk score (odds ratio: 2.229, P=0.049).
Conclusions:
The incidence of acidosis soon after reperfusion was associated with CIN in patients with a first-time ST-segment elevation myocardial infarction.
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