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Published on: May 28, 2019
Inter-arm blood pressure difference is associated with contrast-induced nephropathy in patients with ST-segment
Zeki Simsek1, Regayip Zehir1, Sedat Kalkan1
1Cardiology Department, Kartal Kosuyolu Heart Research and Training Hospital, Istanbul, Turkey.
Insights
An interarm systolic blood pressure difference (IASBD) ≥10 mmHg may predict contrast-induced nephropathy (CIN) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (p-PCI). This finding offers a new risk stratification tool for CIN development.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Contrast-induced nephropathy (CIN) is a significant complication following primary percutaneous coronary intervention (p-PCI) in ST-segment elevation myocardial infarction (STEMI) patients.
- An interarm systolic blood pressure difference (IASBD) ≥10 mmHg is an established risk factor for cardiovascular disease and mortality.
Purpose of the Study:
- To investigate the predictive value of IASBD for CIN risk in STEMI patients undergoing p-PCI.
- To assess if IASBD can serve as an early indicator for CIN development.
Main Methods:
- A prospective study of 2120 STEMI patients undergoing p-PCI.
- CIN defined as a ≥25% or ≥0.5 mg/dL increase in serum creatinine within 72 hours of contrast exposure.
- IASBD measured on emergency department admission.
Main Results:
- The incidence of CIN was 6.6%.
- Patients with CIN had higher rates of age, baseline creatinine, diabetes mellitus, hypertension, and anemia.
- An IASBD ≥10 mmHg was significantly more prevalent in the CIN group (9.3% vs. 4.1%, p=0.001).
- Multivariate analysis identified IASBD as an independent predictor of CIN (OR: 2.36, 95% CI: 1.42-3.90, p=0.001).
Conclusions:
- IASBD on admission is a potential predictor of CIN in STEMI patients undergoing p-PCI.
- This simple measurement could aid in identifying high-risk patients for CIN.
Objective:
Contrast-induced nephropathy (CIN) is a serious complication in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (p-PCI). An interarm systolic blood pressure difference (IASBD) ≥10 mmHg has been identified as an independent risk factor for cardiovascular disease and mortality. The aim of this study was to evaluate the predictive value of the IASBD for the risk of CIN in patients with STEMI who underwent p-PCI.
Method:
We prospectively investigated 2120 consecutive patients who were hospitalized with a diagnosis of STEMI and underwent p-PCI. A relative increase in serum creatinine levels of ≥ 25% or an absolute increase of ≥ 0.5 mg/dL from baseline within 72 h of contrast exposure was defined as CIN. The IASBD was calculated on admission to the emergency department. The risk of CIN was evaluated.
Results:
The incidence of CIN was 6.6% (n = 139). The patients were divided into 2 groups based on the development of CIN. Age (p = .001), baseline creatinine levels (p < .001), DM (p < .001), HT (p < .001) and anemia (p = .001) were higher in patients with CIN. An IASBD ≥10 mmHg was noted in 13 (9.3%) patients in the CIN group and 83 (4.1%) (p = .001) in the non-CIN group (Table 1). According to the multivariate analysis, the IASBD was found to be a predictor of CIN development (OR: 2.36, 95% CI: 1.42-3.90, p: 0.001).
Conclusion:
The IASBD on admission can be a potential predictor of CIN development in patients with STEMI who underwent p-PCI.
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