Contrast-induced nephropathy after primary angioplasty for acute myocardial infarction

Abstract

Nefropatia induzida por contraste após angioplastia primária no infarto agudo do miocárdio Contrast-induced nephropathy after primary angioplasty for acute myocardial infarctionIntrodução: A prevenção da nefropatia induzida por contraste (NIC) é difícil nas situações de emergência, tornando essenciais estudos sobre NIC em pacientes submetidos à angioplastia de urgência. Objetivo: Determinar a incidência e fatores associados à NIC em pacientes com infarto agudo do miocárdio (IAM) submetidos à angioplastia nas primeiras 12 horas após início dos sintomas. Métodos: Foram estudados 201 casos consecutivos de IAM com supradesnivelamento do segmento ST com menos de 12 horas de evolução. Todos os pacientes foram submetidos ao mesmo protocolo de angioplastia. A NIC foi definida como elevação absoluta da creatinina de pelo menos 0,5 mg/dL e/ou aumento relativo da creatinina de 25% em relação ao valor basal no período entre 48 e 72 horas após a administração do contraste. As variáveis que diferiram entre os pacientes com e sem NIC na análise univariada foram analisadas por regressão logística. Resultados: A amostra foi formada por 135 (67,2%) homens e 66 (32,8%) mulheres com idade média de 66,6 ± 11,7 anos. A incidência de NIC foi de 23,8%. Na análise univariada os pacientes com NIC eram mais idosos e com maior frequência de fração de ejeção do ventrículo esquerdo ≤ 40% e da classificação Killip ≥ 2. Na análise multivariada não foram encontrados preditores independentes de NIC. Conclusão: A NIC acomete ¼ dos pacientes com IAM submetidos à angioplastia sem variáveis preditoras. Esse resultado ressalta a necessidade de medidas preventivas para NIC após uso de contraste em angioplastia de urgência. ResumoPalavras-chave: angioplastia coronária com balão; infarto do miocárdio; lesão renal aguda; meios de contraste. Introduction:The prevention of contrastinduced nephropathy (CIN) is difficult in emergency situations, making it essential to study CIN in patients submitted to urgent angioplasty. Objective: To determine the incidence and associated factors to CIN in patients with myocardial infarction (MI) submitted to primary angioplasty in the first 12 hours after onset of symptoms. Methods: We studied 201 consecutive cases of MI with ST-segment elevation with less than 12 hours of evolution. All patients were submitted to the same angioplasty protocol. CIN was defined as an absolute increase of creatinine of at least 0.5 mg/ dL and/or a relative increase of creatinine of 25% in relation to baseline in a period between 48 and 72 hours after contrast administration. The variables that differed between patients with and without CIN in univariate analysis were analyzed by logistic regression. Results: The sample was formed by 135 (67.2%) men and 66 (32.8%) women, with mean age of 66.6 ± 11.7 years. The incidence of CIN was 23.8%. In univariate analysis the patients with CIN were older and had higher frequency of left ventricular ejection fraction ≤ 40% and Killip classification ≥ 2. In multivariate analysis, we did not find independe...

Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction: Is it Affected by Treatment Strategy?

“…The incidence of CIN varies greatly after coronary angiography and may be as low as 6% in patients undergoing elective catheterization [12]. The incidence of CIN in the study of Tziakas et al [13] was about 16% in both elective and urgent catheterization, and it reached 25% in urgent catheterization [14]. Mehran et al [15] showed that the overall occurrence of CIN in 8,357 patients was 13.1%.…”

“…However, it is unlikely that contrast media is the sole factor responsible for AKI in the patients undergoing PCI. Conditions resulting in hypotension, hemodynamic instability, or cardiogenic shock and acute heart failure are additional contributing factors that may lead directly to AKI or potentiate the effects of contrast media [14]. Consequently, in the setting of PCI, most AKI events likely have alternative and multiple etiologies.…”

Contrast-Induced Nephropathy in patients submitted to percutaneous coronary intervention: an integrative review

“…Contrast-induced nephropathy after primary angioplasty for acute myocardial infarction/Santos et al/2015/Brazil/ J Bras Nefrol (19) .…”

Very Early Versus Early Percutaneous Coronary Intervention in Patients with Decreased e-GFR after Successful Fibrinolytic Therapy

“…CIN is defined as increase in serum creatinine level by ≥0.5 mg/dl above the admission value or a >25% relative rise during the first 72 hours after the procedure [12]. The incidence of CIN after PPCI is increasing due to the emergency condition, as there is no time for implementation of prophylactic measures against CIN in high-risk patients and dealing with hemodynamic compromise [13].…”