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Low Preoperative Mean Arterial Pressure as a Risk Factor for Contrast-Induced Nephropathy After Rotational
Xiaogang Liu1, Lei Wan1, Xinying Wu1
1Department of Cardiology, Wuhan Fourth Hospital, 430033 Wuhan, Hubei, China.
Insights
Patients undergoing rotational atherectomy (RA) with low mean arterial pressure (MAP) <80 mmHg face a higher risk of contrast-induced nephropathy (CIN). Intensive monitoring is crucial for these patients to prevent CIN.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Contrast-induced nephropathy (CIN) is a significant complication after cardiovascular procedures.
- Rotational atherectomy (RA) is used for severely calcified coronary lesions, posing a risk for CIN.
- Identifying CIN risk factors post-RA is crucial for patient management.
Purpose of the Study:
- To identify risk factors for contrast-induced nephropathy (CIN) following rotational atherectomy (RA).
- To facilitate the prevention of CIN in patients with severely calcified coronary lesions undergoing RA.
Main Methods:
- Retrospective analysis of 111 patients undergoing RA.
- Creatinine levels assessed 48-72 hours post-RA to identify CIN.
- Propensity score matching (caliper value 0.02) created matched CIN and non-CIN groups (13 pairs).
Main Results:
- A preoperative mean arterial pressure (MAP) <80 mmHg was identified as a significant risk factor for CIN (OR = 17.865, p < 0.05).
- Patients in the CIN group had a higher rate of preoperative heart failure (p < 0.05).
- No significant difference in 1-year MACCEs or secondary endpoints between groups.
Conclusions:
- Preoperative MAP <80 mmHg increases the risk of CIN after RA.
- Patients with preoperative MAP <80 mmHg require intensive monitoring and timely management strategies to prevent CIN.
- Proactive management can mitigate adverse effects of CIN post-RA treatment.
Background:
This study aimed to identify risk factors for contrast-induced nephropathy (CIN) following rotational atherectomy (RA) in patients with severely calcified coronary lesions to facilitate the prevention of CIN.
Methods:
A retrospective analysis was performed on 111 patients who underwent RA in Wuhan Fourth Hospital from July 2021 to June 2023. The creatinine levels of the patients were detected within 48-72 hours after RA, and the patients were divided into a CIN (n = 16) and a non-CIN group (n = 95). Propensity score matching was applied with a caliper value set at 0.02, resulting in 13 matched patient pairs. The risk factors for CIN after RA in these patients were analyzed.
Results:
A total of 16 cases of CIN occurred among the 111 patients with coronary heart disease who underwent RA. Following propensity score matching, 13 patients were included in both the CIN and non-CIN groups. The rates of heart failure were significantly higher in the CIN group than those in the non-CIN group before RA (all p < 0.05). However, there was no significant difference in preoperative mean arterial pressure (MAP) between the two groups. Nonetheless, the rate of patients with preoperative MAP <80 mmHg was higher in the CIN group than in the non-CIN group (53.8% vs. 7.7%; p < 0.05). The coronary artery lesion characteristics and interventional treatment strategies were comparable between the two patient groups. Moreover, no statistically significant difference was observed in 1-year major adverse cardiovascular and cerebrovascular events (MACCEs) or secondary endpoint events between the two groups. Logistic regression analysis showed that among the risk factors for CIN after RA, preoperative MAP <80 mmHg (odds ratio (OR) = 17.865, 95% confidence interval (CI): 1.135-281.246) was a risk factor for CIN (p < 0.05).
Conclusion:
Patients with a preoperative MAP below 80 mmHg are at increased risk of CIN following RA. This cohort requires intensive monitoring to prevent CIN, ensuring prompt implementation of management strategies to avert CIN onset and mitigate the adverse effects of CIN post-RA treatment.
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