Risk factors associated with contrast-associated acute kidney injury in ST-segment elevation myocardial infarction
Jiahao Ye1, Chaoyun Liu1, Zhanyu Deng1
1Department of Cardiology, Guangzhou Red Cross Hospital, Guangzhou, Guangdong Province, China.
Insights
This review identified risk factors for contrast-associated acute kidney injury (CA-AKI) in ST-elevation myocardial infarction patients. Older age, female sex, and comorbidities increased CA-AKI risk, while smoking and family history of coronary artery disease (CAD) showed a protective effect.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Contrast-associated acute kidney injury (CA-AKI) is a significant concern in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
- Identifying risk factors is crucial for preventative strategies and improving patient outcomes.
Approach:
- A systematic review and meta-analysis was conducted.
- Searched PubMed, Embase, and Ovid databases up to February 2022 for observational studies.
- Included 21 studies with 22,015 participants to evaluate risk factors for CA-AKI.
Key Points:
- Pooled incidence of CA-AKI was 11.91%.
- Risk factors included older age, female sex, hypertension, diabetes, and heart failure.
- Left anterior descending (LAD) artery occlusion, left main disease, and multivessel coronary disease were significant risk factors.
- Increased contrast volume was associated with higher CA-AKI risk.
- Smoking and family history of coronary artery disease (CAD) were unexpectedly associated with a lower risk of CA-AKI.
Conclusions:
- LAD artery infarction, left main disease, and multivessel disease are confirmed risk factors for CA-AKI in STEMI patients undergoing primary PCI.
- The protective association of smoking and family history of CAD warrants further investigation.
Objective:
The objective of this systematic review and meta-analysis was to evaluate the risk factors for contrast-associated acute kidney injury (CA-AKI) in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention.
Design:
Systematic review and meta-analysis.
Data Sources:
We searched the databases of PubMed, Embase and Ovid, up to February 2022, for observational studies that investigated the association between risk factors and CA-AKI.
Results:
A total of 21 studies were included in the meta-analysis. Of the total 22 015 participants, 2728 developed CA-AKI. Pooled incidence was 11.91% (95% CI 9.69%, 14.14%). Patients with CA-AKI were more likely to be older, female, also had comorbidities (hypertension, diabetes, previous heart failure). Smoking (OR: 0.60; 95% CI 0.52, 0.69) and family history of CAD (coronary artery disease) (OR: 0.76; 95% CI 0.60, 0.95) were associated with lower risk of CA-AKI. Left anterior descending (LAD) artery occlusion (OR: 1.39; 95% CI 1.21, 1.59), left main disease (OR: 4.62; 95% CI 2.24, 9.53) and multivessel coronary disease (OR: 1.33; 95% CI 1.11, 1.60) were risk factors for CA-AKI. Contrast volume (weighted mean difference: 20.40; 95% CI 11.02, 29.79) was associated with increased risk in patients receiving iso-osmolar or low-osmolar non-ionic contrast.
Conclusions:
In addition to the known risk factors, LAD artery infarction, left main disease and multivessel disease are risk factors for CA-AKI. The unexpected favourable association between smoking, as well as family history of CAD, and CA-AKI requires further investigation.
Prospero Registration Number:
CRD42021289868.
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