Risk Factors of Contrast-induced Acute Kidney Injury in Patients Undergoing Emergency Percutaneous Coronary Intervention

Yuan, Ying; Qiu, Hong; Hu, Xiaoying; Luo, Tong; Gao, Xiao-Jin; Zhao, Xueyan; Zhang, Jun; Wu, Yujuan; Yan, Hong‐Bin; Qiao, Shubin; Yang, Yuejin; Gao, Runlin

doi:10.4103/0366-6999.196578

Cited by 28 publications

(25 citation statements)

References 30 publications

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“…Moreover, the reduction of the proportion of high-risk cases also decreased the CV. In the present study, not only the mean CV (76.8 mL), but also the proportion of cases with dose greater than 200ml (6.1%) were lower than those of previous studies (6,21,22,29). Meanwhile, the CV was only reduced by 10.8 ml in TA Group.…”

Section: Discussioncontrasting

confidence: 84%

“…After cardiac catheterization, the incidence of CIN may be as low as 6% in patients undergoing elective catheterization (20); and reaching 23.8% in samples involving urgent catheterization (21). Our study showed the incidence of CIN was 11.4% in patients undergoing emergency primary PCI due to STEMI, lower than previous studies (21,22). From the results of statistical analysis, we could nd several characteristics concerning the low occurrence of CIN in our samples, such as lower mean age; lower infused CV (in our study the mean CV was 76.8 ml, well below the cut off points of risk listed in the literature: for some > 200 mL and others > 300 mL) (23,24); lower baseline SCr and only 12 (3.2%) patients with SCr greater than 2 mg/dL, which prevented comparisons of statistical value among patients with SCr equal to or lower versus higher than 2 mg/dL (SCr limit is usually used as a risk criteria for CIN); exclusion of patients with previous AMI, PCI, CABG, stroke, serious peripheral vascular disease, chronic kidney disease, or recent exposure of contrast; elimination of high risk cases and failed operation, such as severe left main disease, preoperative hemodynamic instability, and reoperation or death within 72 hours; and mean total ischemic time was less than 6 hours.…”

Section: Discussionmentioning

confidence: 45%

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Thrombus Aspiration Reduces Contrast Volume in ST-Elevation Myocardial Infarction Patients with High Thrombus Burden

Chen

Tang

Liang

et al. 2021

Preprint

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BACKGROUD Due to the emergency nature of ST-elevation myocardial infarction (STEMI), the estimation of the risk of contrast-induced nephropathy (CIN) is always limited and the hydration prior to primary percutaneous coronary interventions (PCI) is difficult. Minimizing contrast volume (CV) might be the most desirable option for preventing the incidence of CIN in these patients. The improvement of myocardial perfusion due to thrombus aspiration (TA) may be accompanied by a reduction in CV.OBJECTIVES This study aimed to determine the effect of TA prior to angioplasty on CV in patients with STEMI.METHODS Consecutive 380 STEMI patients undergoing primary PCI with high thrombus burden (HTB) were randomly assigned to receive either TA before primary PCI (TA group, n = 190) or primary PCI alone (control group, n = 190). Serum creatinine was detected at the time of admission, and 48 and 72 hours after primary PCI.RESULTS Baseline characteristic were well matched. Although the CV in TA group was significantly lower than that in control group (71.5 ± 15.7 mL vs. 82.3 ± 17.5 mL, p = 0.000), the incidence of CIN was comparable (9.5% vs. 13.3%, p = 0.249). During hospitalization, no significant differences between groups was observed in major bleeding, urgent dialysis, stroke, reoperation after 72 hours, death after 72 hours and total incidence of adverse clinical events.CONCLUSIONS The study demonstrated that TA reduces CV but not CIN or adverse clinical events during hospitalization in STEMI patients undergoing primary PCI with HTB.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 45%

Thrombus Aspiration Reduces Contrast Volume in ST-Elevation Myocardial Infarction Patients with High Thrombus Burden

Chen

Tang

Liang

et al. 2021

Preprint

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“…Hemoglobin levels and GFR were found to be predictors of CIN in patients treated with emergency PCI. 28,29 Mendi et al determined that there was a relationship between serum uric acid levels and CIN in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary PCI. 30 The association of new risk factor profile, which includes white blood cell count, body surface area, history of stroke, baseline SCr, intra-aortic balloon pump, and diuretics usage, with CIN in patients treated with emergency PCI was also reported.…”

Section: Discussionmentioning

confidence: 99%

The Ratio of Fibrinogen to Albumin as a Predictor of Contrast-Induced Nephropathy After Carotid Angiography

2018

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Contrast-induced nephropathy (CIN) is acute kidney failure that occurs after exposure to contrast agent. There is no sensitive biomarker to predict the development of CIN. In a retrospective study, we investigated the predictive value of the fibrinogen to albumin ratio (FAR) to determine the risk of CIN in patients (N = 246) who underwent carotid angiography. Contrast-induced nephropathy was defined as a 0.5 mg/dL or 25% increase in serum creatinine levels 48 to 72 hours following exposure to a radiocontrast agent. Patients were grouped according to whether they developed CIN or not, that is, CIN(–) and CIN(+) groups, respectively. Contrast-induced nephropathy developed in 39 (15.8%) of all the patients. The fibrinogen levels, neutrophil to lymphocyte ratio (NLR), and FAR in the CIN (+) group were higher than in the CIN (−) group ( P < .001). Multivariate analysis showed that age, diabetes, NLR, platelet–lymphocyte ratio, and FAR were independent risk factors for CIN. The area under the curve (AUC) of FAR was 0.800 for the prediction of CIN, and the best cutoff value was 57.4 with sensitivity, specificity, positive predictive value, and negative predictive value of 74.4%, 60.8%, 26.4%, and 92.7%, respectively. The FAR may be useful as a predictor of CIN.

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“…It has also been identified that a small body surface area is linked with an increased risk of CI-AKI in emergency PCI patients in our previous studies. [ 27 28 ] Forth, the present findings might be as a result of the high sensitivity of the CI-AKI definition and the special nature of the study population. [ 11 27 ] A higher eGFR usually came from a relatively lower SCr correspondingly, which was more apt to be diagnosed as CI-AKI due to a slight but ≥25% fluctuation of SCr above baseline.…”

Section: Discussionmentioning

confidence: 90%

Relationship between High Level of Estimated Glomerular Filtration Rate and Contrast-Induced Acute Kidney Injury in Patients who Underwent an Emergency Percutaneous Coronary Intervention

Yuan

Qiu

et al. 2018

Chinese Medical Journal

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Background:Mounts of studies have shown that low estimated glomerular filtration rate (eGFR) is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury (CI-AKI) in a Chinese population who underwent an emergency percutaneous coronary intervention (PCI).Methods:Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint (including nonfatal myocardial infarction, revascularization, stroke, and all-cause death) at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was performed.Results:A total of 1061 patients were included and the overall CI-AKI rate was 22.7% (241/1061). The separate rates were 77.8% (7/9) in Group 1 (eGFR ≥120 ml·min−1·1.73 m−2), 26.0% (118/454) in Group 2 (120 ml·min−1·1.73 m−2> eGFR ≥90 ml·min−1·1.73m−2), 18.3% (86/469) in Group 3 (90 ml·min−1·1.73 m−2> eGFR ≥60 ml·min−1·1.73 m−2), 21.8% (26/119) in Group 4 (60 ml·min−1·1.73 m−2> eGFR ≥30 ml·min−1·1.73 m−2), and 40.0% (4/10) in Group 5 (eGFR <30 ml·min−1·1.73 m−2), with statistical significance (χ2 = 25.19, P < 0.001). The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing (the higher the level of eGFR, the higher the CI-AKI occurrence in case of eGFR ≥60 ml·min−1·1.73 m−2). The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences (χ2 = 16.26, P = 0.009 at 6-month follow-up, and χ2 = 49.05, P < 0.001 at 12-month follow-up). The logistic analysis confirmed that eGFR was one of independent risk factors of CI-AKI in emergency PCI patients.Conclusions:High level of eGFR might be associated with increased risk of CI-AKI in patients with emergency PCI, implying for future studies and risk stratification in clinical practice.

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Risk Factors of Contrast-induced Acute Kidney Injury in Patients Undergoing Emergency Percutaneous Coronary Intervention

Cited by 28 publications

References 30 publications

Thrombus Aspiration Reduces Contrast Volume in ST-Elevation Myocardial Infarction Patients with High Thrombus Burden

Thrombus Aspiration Reduces Contrast Volume in ST-Elevation Myocardial Infarction Patients with High Thrombus Burden

The Ratio of Fibrinogen to Albumin as a Predictor of Contrast-Induced Nephropathy After Carotid Angiography

Relationship between High Level of Estimated Glomerular Filtration Rate and Contrast-Induced Acute Kidney Injury in Patients who Underwent an Emergency Percutaneous Coronary Intervention

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