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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction: Is it Affected by Treatment
Mohamed Khalfallah1, Mohamed Abdalaal1, Mona Adel1
1Department of Cardiology, Tanta University Hospital, Tanta, Egypt.
Insights
Contrast-induced nephropathy (CIN) occurred slightly less with pharmacoinvasive strategy (PIS) than primary PCI, but not significantly. Advanced age, diabetes, hypertension, high contrast volume, and shock predict CIN, which increases mortality.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Contrast-induced nephropathy (CIN) is a significant complication following percutaneous coronary intervention (PCI).
- CIN particularly impacts morbidity and mortality in ST-segment elevation myocardial infarction (STEMI) patients.
Purpose of the Study:
- To compare the incidence, risk factors, and in-hospital outcomes of CIN.
- To evaluate CIN in STEMI patients managed with pharmacoinvasive strategy (PIS) versus primary PCI (PPCI).
Main Methods:
- A study involving 670 STEMI patients divided into PPCI and PIS groups.
- Comparison of CIN incidence, risk factors, and major adverse cardiac events (MACE) between the two management strategies.
Main Results:
- CIN incidence was 10.9% in the PPCI group and 8.8% in the PIS group (p=0.365).
- Independent predictors of CIN included advanced age (>60), diabetes, hypertension, contrast volume (>180 ml), and cardiogenic shock.
- Patients with CIN experienced significantly higher mortality and MACE.
Conclusions:
- The incidence of CIN was not significantly different between PIS and PPCI strategies.
- Key predictors for CIN are advanced age, comorbidities (diabetes, hypertension), high contrast volume, and cardiogenic shock.
- CIN is associated with increased in-hospital mortality and adverse cardiac events.
Background:
Contrast-induced nephropathy (CIN) is a frequent complication after percutaneous coronary intervention (PCI) and severely affects morbidity and mortality, especially in patients with ST-segment elevation myocardial infarction.
Objective:
This study sought to determine the incidence, risk factors, and in-hospital outcome of CIN in patients with ST-segment elevation myocardial infarction managed by pharmacoinvasive strategy (PIS) versus those managed by primary PCI (PPCI).
Methods:
The study was conducted on 670 patients with ST-segment elevation myocardial infarction divided into 2 groups: group I (PPCI group) and group II (PIS group), the 2 groups were compared with each other for the incidence of CIN, risk factors, and in-hospital major adverse cardiac events.
Results:
The incidence of CIN in the PIS group (30 patients, 8.8%) was lower than PPCI group (36 patients, 10.9%); however, there was no statistically significant difference between the 2 groups (p = 0.365). Multivariate regression analysis showed that advanced age >60 years (odds ratio [OR] = 4.453; 95% confidence interval [CI]: 2.489 to -7.967; p = 0.001), history of diabetes mellitus (OR = 2.366; 95% CI: 1.298 to -4.315; p = 0.005) and hypertension (OR = 1.930; 95% CI: 1.053 to -3.539; p = 0.034), volume of contrast agent >180 ml (OR = 2.276; 95% CI: 1.290 to -4.016; p = 0.005), and cardiogenic shock (OR = 4.098; 95% CI: 1.726 to -9.728; p = 0.001) were the independent predictors of CIN. Mortality and major adverse cardiac events were significantly higher in patients with CIN.
Conclusions:
The incidence of CIN was slightly lower in PIS as compared to PPCI; however, this reduction was not statistically significant. The independent predictors of CIN were advanced age, history of diabetes mellitus and hypertension, high dose of contrast agent, and cardiogenic shock.
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