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Efficacy of Coronary Sinus Aspiration in Reducing Contrast-Induced Nephropathy in High-Risk Patients
Somil Verma1, Anwar Hussain Ansari1, Rajesh Kumar2
1Department of Cardiology, VMMC and Safdarjung Hospital, New Delhi, India.
Insights
Coronary sinus aspiration (CSA) reduced contrast-induced nephropathy (CIN) rates in high-risk patients undergoing coronary angioplasty. While effective, procedural complications warrant further investigation in larger studies.
Area of Science:
- Cardiology
- Nephrology
- Interventional Radiology
Background:
- Contrast-induced nephropathy (CIN) is a significant risk following angiographic procedures.
- Coronary sinus aspiration (CSA) is an emerging technique to minimize renal contrast exposure.
Purpose of the Study:
- To assess CIN incidence in high-risk patients undergoing coronary angioplasty with or without CSA.
- Evaluate the efficacy of CSA in preventing CIN in a vulnerable patient population.
Main Methods:
- A single-center, prospective, single-blind randomized controlled trial involving 70 high-risk patients.
- Patients were randomized to either coronary angioplasty with CSA or standard coronary angioplasty.
- CIN was defined as a serum creatinine increase of ≥25% or 0.5 mg/dL within 3 days post-procedure.
Main Results:
- The study included 66 patients (diabetes, CKD stage 3); 33 in the CSA group and 33 in the control group.
- CIN rates were significantly lower in the CSA group (15.2%) compared to the control group (39.4%) (P=0.027).
- Mean injected contrast was 65.2 mL, with an average aspiration of 18.7 mL; no significant differences in post-procedure creatinine or eGFR were observed.
Conclusions:
- CSA demonstrated a reduction in CIN rates among high-risk patients undergoing coronary angioplasty.
- Potential procedural complications associated with CSA require careful consideration.
- Further large-scale studies are necessary to solidify the role of CSA in this patient cohort.
Background:
Contrast-induced nephropathy (CIN) is a complication of angiographic procedures. Coronary sinus aspiration (CSA) is a novel technique aimed at reducing renal exposure to contrast and mitigating the risk of CIN.
Objectives:
The aim of the study was to evaluate the rates of CIN in high-risk patients with and without CSA at the time of coronary angioplasty.
Methods:
In this single-center, prospective, single-blind randomized controlled trial, 70 high-risk patients undergoing coronary angioplasty were randomized into 2 groups: the intervention group (coronary angioplasty with CSA) and the control group (coronary angioplasty). The primary outcome was the proportion of patients developing CIN (defined as an increase in serum creatinine of at least 25% or 0.5 mg/dL within 3 days following the procedure).
Results:
In total, 70 patients with diabetes and chronic kidney disease 3 (mean age 60.6 ± 8.7 years) were included. Of the 37 participants initially allocated to CSA, 4 were excluded (3 due to difficulties in coronary sinus cannulation and 1 due to a procedural complication). The mean volume of injected contrast was 65.2 ± 23 mL and the estimated volume of aspirated contrast was 18.7 ± 7.1 mL. Among the 66 remaining patients, the rate of CIN was lower in the intervention group (5/33, 15.2%) compared to the control group (13/33, 39.4%) (P = 0.027). There were no differences in postprocedural serum creatinine and estimated glomerular filtration rate.
Conclusions:
While CSA was associated with lower rates of CIN in high-risk patients undergoing coronary angioplasty, procedural complications can occur. Larger studies are needed to understand the role of CSA for high-risk patients undergoing coronary angioplasty.
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