Contrast-Induced Nephropathy in STEMI Patients With and Without Chronic Kidney Disease

Document Type

Article

Publication Date

3-1-2018

Publication Title

Crit Pathw Cardiol

Keywords

Acute Kidney Injury, Age Factors, Aged, Aged, 80 and over, Cardiac Catheterization, Case-Control Studies, Comorbidity, Contrast Media, Coronary Angiography, Creatinine, Diabetes Mellitus, Female, Hospital Mortality, Humans, Incidence, Length of Stay, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Percutaneous Coronary Intervention, Peripheral Arterial Disease, Renal Dialysis, Renal Insufficiency, Chronic, Retrospective Studies, Risk Factors, ST Elevation Myocardial Infarction, Shock, Cardiogenic

Abstract

INTRODUCTION: Contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) is associated with adverse outcomes; however, there are scarce data comparing clinical outcomes of post-PCI CIN in ST elevation myocardial infarction (STEMI) patients with and without chronic kidney disease (CKD). We sought to assess the incidence, clinical predictors, and short-term and long-term clinical outcomes of post-PCI CIN in STEMI patients with and without CKD.

METHODS: We performed a retrospective observational cohort study involving 554 patients who underwent PCI for STEMI from February 2010 to November 2013. CKD was defined as estimated glomerular filtration rate ≤60 mL/min and CIN as creatinine increase by ≥25% or ≥0.5 mg/dL from baseline within 72 hours after catheterization contrast exposure.

RESULTS: In the entire population, CIN developed in 89 (16%) patients. The incidence of CIN was 19.7% (27/137) in CKD patients and 11.1% (62/417) in non-CKD patients, P < 0.05. Univariate analysis predictors of CIN were older age (65 vs. 60 years), diabetes (35% vs. 21%), peripheral artery disease (11% vs. 5%), cardiogenic shock (24% vs. 13%), hemodynamic support placement (34% vs. 14%), and Mehran score (9.4 ± 7 vs. 5.4 ± 5.2) with all P < 0.05. The predictors of CIN were the same across the CKD and non-CKD cohort with the exception of diabetes. In multivariate analysis, the strongest predictor of CIN in CKD patients was diabetes (odds ratio, 5.8; CI, 1.8-18.6); however, diabetes was not a predictor in the non-CKD population. In the non-CKD population, each single unit increase in the Mehran score was associated with a 1.1 times greater likelihood of CIN (odds ratio, 1.1; CI, 1.01-1.2). Patients with CIN had higher rates of inpatient mortality (14.6% vs. 2.8%), longer length of hospitalization (8 ± 11 vs. 3.4 ± 4.4 days), need for inpatient dialysis (11.2% vs. 0%), higher 30-day mortality (14.6% vs. 3.0%), and higher incidence of long-term serum creatinine >0.5 mg/dL from baseline (16.9% vs. 2.4%) with all P < 0.05.

CONCLUSIONS: Overall, we found that CKD patients undergoing PCI for STEMI have a higher incidence of CIN than non-CKD patients. CIN confers worse short-term and long-term outcomes irrespective of baseline renal function.

Medical Subject Headings

Acute Kidney Injury; Age Factors; Aged; Aged, 80 and over; Cardiac Catheterization; Case-Control Studies; Comorbidity; Contrast Media; Coronary Angiography; Creatinine; Diabetes Mellitus; Female; Hospital Mortality; Humans; Incidence; Length of Stay; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Percutaneous Coronary Intervention; Peripheral Arterial Disease; Renal Dialysis; Renal Insufficiency, Chronic; Retrospective Studies; Risk Factors; ST Elevation Myocardial Infarction; Shock, Cardiogenic

PubMed ID

29432373

Volume

17

Issue

1

First Page

25

Last Page

31

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