ACE inhibitors and arbs in post-percutaneous coronary intervention contrast-induced nephropathy (cin): To hold or not to hold?
Mawri S, Michaels A, Gibbs J, Nakhle A, Assar S, Novak J, Zweig B. ACE inhibitors and arbs in post-percutaneous coronary intervention contrast-induced nephropathy (cin): To hold or not to hold? JACC Cardiovasc Interv. Feb 2018;11(4):S22-S22.
JACC Cardiovasc Interv
Contrast-induced nephropathy (CIN) is a frequent adverse outcome from percutaneous coronary intervention (PCI). It is common practice to hold angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) in patients who develop CIN, with the intention to resume as outpatients. This study investigated whether discontinuation of ACEI/ARB in post-PCI CIN was associated with differences in major adverse cardiac or cerebral events (MACCE) and initiation of hemodialysis (HD).
We performed a retrospective study of 414 patients who underwent PCI from 2008 to 2013 and developed CIN, defined as an increase in serum creatinine level of 0.5 mg/dl or 25% from baseline at 48-72 hours after contrast exposure. One hundred fifty-one patients were identified after excluding those who did not meet the criteria for CIN or were not taking ACEI/ARB prior to hospitalization. Chi-square, Fisher’s exact, and Wilcoxon rank-sum tests were used to analyze differences in MACCE or HD between post-PCI CIN patients who continued versus discontinued ACEI/ARB. Cox regression analysis was used to assess ACEI/ARB continuation status as a predictor of MACCE or HD.
Among the 151 patients with CIN, 77 (51%) had their ACEI/ARB continued at hospital discharge, 47 (31%) had their ACEI/ARB discontinued, and 27 (18%) died during hospitalization. There were no significant differences in MACCE or HD between patients in the ACEI/ARB continuation versus discontinuation groups at 1 year of follow-up; however, there was a trend toward more PCI in patients who discontinued ACEI/ARB (17% versus 6.5%, p = 0.076). Cox regression analysis demonstrated that continuation of ACEI/ARB at hospital discharge was not a statistically significant predictor of MACCE or HD at 1 year of follow-up.
In patients with CIN after PCI, there is no benefit from holding ACEI/ARB at hospital discharge. Further prospective studies should be performed to confirm these findings.