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Evaluation of contrast nephropathy in percutaneous treatment of chronic total occlusions
Erdal Aktürk1, Lütfü Aşkın1, Hakan Taşolar2
1Faculty of Medicine, Department of Cardiology, Adiyaman University, Adiyaman, Turkey.
Insights
Intensive hydration during percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) is effective. This method helps prevent contrast-induced nephropathy (CIN) in patients without heart failure.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Contrast-induced nephropathy (CIN) is a significant complication following percutaneous coronary intervention (PCI).
- Chronic total occlusions (CTO) are common in patients undergoing coronary angiography, increasing CIN risk.
Purpose of the Study:
- To evaluate the efficacy of intensive hydration protocols in preventing CIN in CTO-PCI patients.
- To compare standard hydration versus intensive hydration during CTO-PCI procedures.
Main Methods:
- A study involving 128 CTO patients compared standard hydration (1 ml/kg/h) with intensive hydration (12 ml/kg/h) during PCI.
- Data collected included Mehran score, lesion characteristics, procedure details, and serological markers.
- CIN development was monitored post-procedure.
Main Results:
- CIN incidence was similar between standard and intensive hydration groups (4 vs. 5 patients).
- Standard hydration involved significantly more saline volume (1767 ± 192.2 ml) compared to intensive hydration (1043.6 ± 375 ml).
- Pre-existing high creatinine, older age, lower ejection fraction, and diabetes mellitus were predictors of CIN.
Conclusions:
- Intensive hydration is a cost-effective strategy for CIN prevention in CTO-PCI patients.
- This approach is particularly beneficial for patients without left ventricular dysfunction.
Background:
Contrast-induced nephropathy (CIN) is a leading cause of morbidity and mortality in patients undergoing percutaneous coronary intervention (PCI). Chronic total occlusions (CTO) are frequently observed among patients undergoing coronary angiography.
Methods:
A total of 128 CTO patients were included. Mehran score, lesion characteristics, interventional procedure, serological specimens and devices were recorded. The first group was administered with 1 ml · kg-1 · h-1 saline (0.9% NaCl) infusion that started 12 h before the procedure and continued 12 h post procedure as recommended by the guidelines. The second group was administered with saline infusion of 12 ml · kg-1 · h-1 only during CTO-PCI procedure, which is called as intensive infusion.
Results:
CIN development was similar in two groups (four patients in standard hydration group and five patients in intensive hydration group). The amount of saline was significantly higher in the standard group (1,767 ± 192.2 vs. 1,043.6 ± 375; p < 0.001). Patients with higher creatinine levels prior to PCI had a higher rate of CIN development after procedure. Interestingly, age, left ventricular ejection fraction, and diabetes mellitus independently predicted CIN.
Conclusion:
Intensive hydration administration appears to be an effective and cost-effective method in CTO-PCI patients, especially in patients without left ventricular function failure.
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