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Contrast-Induced Nephropathy and Long-Term Mortality After Percutaneous Coronary Intervention in Patients With Acute
Guoli Sun1,2, Pengyuan Chen2, Kun Wang2
11 Guangdong General Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Insights
Contrast-induced nephropathy (CIN) increases long-term mortality in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI), even with stable hemodynamics. This risk persists regardless of left ventricular ejection fraction (LVEF) or hemodynamic stability.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Abnormal hemodynamics are linked to contrast-induced nephropathy (CIN) and mortality risk.
- Limited research exists on CIN's impact in patients with stable hemodynamics and preserved left ventricular ejection fraction (LVEF).
Purpose of the Study:
- To investigate the effect of CIN on long-term mortality in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) with relatively stable hemodynamics.
Main Methods:
- Observational study including 696 AMI patients undergoing PCI.
- Exclusion criteria: reduced LVEF (<40%) and abnormal hemodynamics.
- Primary endpoint: long-term, all-cause mortality over a mean follow-up of 2.79 years.
Main Results:
- CIN developed in 15.8% of patients.
- All-cause mortality was significantly higher in the CIN group (24%) versus the non-CIN group (3.4%).
- CIN was an independent predictor of mortality (adjusted HR: 2.97). Renal insufficiency (adjusted HR: 4.40) also predicted mortality, while beta-blocker use (adjusted HR: 0.33) was protective.
Conclusions:
- Contrast-induced nephropathy independently predicts long-term mortality in AMI patients after PCI.
- This association holds true irrespective of left ventricular ejection fraction impairment or hemodynamic instability.
Abstract:
Abnormal hemodynamics is thought to contribute to the increased risk of contrast-induced nephropathy (CIN) and mortality. However, few studies focused on patients without abnormal hemodynamics (defined as hypotension, intra-aortic balloon pump usage) and reduced left ventricular ejection fraction (LVEF < 40%). Our study was to explore the impact of CIN on mortality in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) with relative stable hemodynamics. In this observational study, we included 696 patients with AMI undergoing PCI without reduced LVEF and abnormal hemodynamics. The end point was long-term, all-cause mortality. During the mean follow-up of 2.79 years, CIN was detected in 110 (15.8%) patients. The total all-cause mortality was higher in CIN group than that in non-CIN group (24% vs 3.4%, P < .001). In the multivariate Cox analysis, CIN was an independent predictor of worse outcomes (adjusted hazard ratio [HR]: 2.97, 95% confidence interval: 1.46-6.06, P < .001) and significantly associated with long-term mortality, so did renal insufficiency (adjusted HR: 4.40, P < .001) and use of β-blockers (adjusted HR: 0.33, P < .001). Among patients with AMI, CIN independently predicted long-term mortality following PCI, regardless of LVEF impairment and abnormal hemodynamics.
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