Risk factors of contrast-induced nephropathy in patients with acute coronary syndrome
Tomasz Rakowski1, Artur Dziewierz2, Michał Węgiel2
1Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland. mcrakows@cyfronet.pl.
Insights
Contrast-induced nephropathy (CIN) persisted in over 10% of acute coronary syndrome (ACS) patients until discharge. Anemia, STEMI, and immediate PCI independently predicted CIN, requiring targeted preventive strategies.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Acute coronary syndrome (ACS) patients face high risks of contrast-induced nephropathy (CIN).
- CIN is typically considered transient, but its persistence until hospital discharge in ACS patients needs further analysis.
- Persistent CIN is linked to adverse outcomes, including prolonged hospitalization and increased morbidity/mortality.
Purpose of the Study:
- To investigate the incidence and predictors of CIN persisting until hospital discharge in a contemporary ACS population undergoing invasive procedures.
- To identify patient subgroups at higher risk for persistent CIN.
Main Methods:
- Prospective registry of 2638 consecutive ACS patients.
- CIN defined as a 25% serum creatinine increase from baseline or a 0.5 mg/dl absolute increase.
- Logistic regression analysis to identify independent predictors of CIN.
Main Results:
- 10.7% of ACS patients exhibited CIN at hospital discharge.
- Immediate percutaneous coronary intervention (PCI) post-angiography was linked to higher CIN rates (P < 0.001).
- Baseline anemia (17.9% vs. 10% CIN incidence, P < 0.001), ST-segment elevation myocardial infarction (STEMI) presentation, and immediate PCI were independent CIN predictors.
Conclusions:
- Persistent CIN occurs in over 10% of ACS patients despite supportive care.
- Anemia, STEMI, and immediate PCI are key independent predictors of persistent CIN.
- Preventive measures should prioritize ACS patients with baseline anemia, STEMI, or those undergoing immediate PCI.
Background:
Patients with acute coronary syndrome (ACS) are at high risk of contrast-induced nephropathy (CIN), which is associated with prolonged hospitalization, higher morbidity and mortality after angiographic procedures. The occurrence of CIN is regarded as a transient and reversible condition. However, the persistence of CIN until hospital discharge in patients with ACS has not been thoroughly analyzed.
Aims:
We aimed to analyze CIN persistent until hospital discharge in contemporary ACS population referred to invasive diagnostics and treatment.
Methods:
A total of 2638 consecutive patients with ACS were included in a prospective registry. The occurrence of CIN was defined as a 25% increase in serum creatinine from baseline or a 0.5 mg/dl (44 μmol/l) increase in the absolute value.
Results:
Criteria of CIN at hospital discharge were met in 10.7% of patients. Immediate percutaneous coronary intervention (PCI) after angiography (67% of patients) was associated with higher rates of CIN compared to patients referred for other treatment strategies (P < 0.001). The logistic regression model showed that anemia at baseline (8.7% of patients) was an independent predictor of CIN, which occurred in 17.9% of anemic patients and 10% of patients without anemia (P < 0.001). Also, ST-segment elevation myocardial infarction (STEMI) presentation and immediate PCI were independent predictors of CIN.
Conclusions:
Despite intravenous fluid administration during the hospital stay, CIN persisted until hospital discharge in more than 10% of patients with ACS. Anemia at baseline, STEMI presentation, and immediate PCI strategy were independent predictors of CIN. Thus, preventive actions should be specially aimed at those groups of patients.
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