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Acute hyperglycemia and contrast-induced nephropathy in patients with non-ST elevation myocardial infarction

Onur Baydar¹, Alparslan Kilic¹

¹Department of Cardiology, Koc University Hospital, Istanbul, Turkey.

Cardiovascular Endocrinology & Metabolism

|February 28, 2020

Insights

Acute hyperglycemia, or high blood sugar, is linked to a higher risk of contrast-induced nephropathy (CIN) in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI). This association also correlates with increased in-hospital mortality.

Area of Science:

Cardiology
Nephrology
Endocrinology

Background:

Acute hyperglycemia and contrast-induced nephropathy (CIN) are common complications in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI).
Both conditions are independently associated with increased mortality rates in this patient population.

Purpose of the Study:

To investigate the potential association between acute hyperglycemia and the incidence of CIN in NSTEMI patients undergoing PCI.
To identify risk factors for CIN in this cohort.

Main Methods:

Retrospective analysis of 281 NSTEMI patients undergoing PCI.
Acute hyperglycemia defined as plasma glucose > 198 mg/dL upon admission.
CIN defined as a serum creatinine increase of 25% or 0.5 mg/dL within 48-72 hours post-PCI.

Main Results:

44% of patients (15.7%) presented with acute hyperglycemia.
Patients with acute hyperglycemia had a significantly higher incidence of CIN (29.5% vs. 5.1%, P < 0.001).
Hyperglycemic patients also showed higher in-hospital mortality, longer hospital stays, and increased rates of major bleeding, mechanical ventilation, and dialysis.

Conclusions:

Acute hyperglycemia is associated with an increased risk of CIN in NSTEMI patients undergoing PCI.
The findings suggest a link between acute hyperglycemia and heightened in-hospital morbidity and mortality in this patient group.

Read full analysis

Abstract:

Acute hyperglycemia and contrast-induced nephropathy (CIN) are frequently observed in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI), and both are associated with an increased mortality rate. We investigated the possible association between acute hyperglycemia and CIN in patients with NSTEMI undergoing PCI.

Materials And Methods:

We retrospectively enrolled 281(149, 53% men) NSTEMI patients undergoing PCI. For each patient, plasma glucose levels were secreened at hospital admission. Acute hyperglycemia was defined as glucose levels > 198 mg/dl. CIN was defined as an increase in serum creatinine 25% or 0.5 mg/dl from baseline in the first 48-72 hours.

Results:

Overall, 44 (15.7%) patients had acute hyperglycemia. Patients with acute hyperglycemia had higher incidence of CIN than those without acute hyperglycemia (29.5 vs 5.1%, P < 0.001). Also, in-hospital mortality, length of hospital stay, major bleeding, requirement of mechanical ventilation and dialysis were observed significantly higher in patients with hyperglycemia. Patients were then reallocated to two groups according to the presence or absence of CIN. Overall, 25 cases (8.9%) of CIN were diagnosed. Diabetes mellitus, weight, age, glucose level and estimated glomerular filtration rate (eGFR) were detected as independent risk factors of CIN. Additionally, admission glucose levels were significantly correlated with creatinine levels after PCI, eGFR and contrast volume/eGFR ratio.

Conclusion:

In NSTEMI patients undergoing primary PCI, acute hyperglycemia may be associated with an increased risk for CIN and in-hospital mortality and morbidity.

Keywords:

hyperglycemia myocardial infarction nephropathy

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