Objective To evaluate the efficacy of aggressive hydration compared with general hydration for contrast-induced acute kidney injury (CI-AKI) prevention among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).
Methods The Aggressive hydraTion in patients with STEMI undergoing pPCI to prevenT Contrast-Induced Acute Kidney Injury study is an open-label, randomised controlled study at 15 teaching hospitals in China. A total of 560 adult patients were randomly assigned (1:1) to receive aggressive hydration or general hydration treatment. Aggressive hydration group received preprocedural loading dose of 125/250 mL normal saline within 30 min, followed by postprocedural hydration performed for 4 hours under left ventricular end-diastolic pressure guidance and additional hydration until 24 hours after pPCI. General hydration group received ≤500 mL 0.9% saline at 1 mL/kg/hour for 6 hours after randomisation. The primary end point is CI-AKI, defined as a >25% or 0.5 mg/dL increased in serum creatinine from baseline during the first 48–72 hours after primary angioplasty. The safety end point is acute heart failure.
Results From July 2014 to May 2018, 469 patients were enrolled in the final analysis. CI-AKI occurred less frequently in aggressive hydration group than in general hydration group (21.8% vs 31.1%; risk ratio (RR) 0.70, 95% CI 0.52 to 0.96). Acute heart failure did not significantly differ between the aggressive hydration group and the general hydration group (8.1% vs 6.4%, RR 1.13, 95% CI 0.66 to 2.44). Several subgroup analysis showed the better effect of aggressive hydration in CI-AKI prevention in male, renal insufficient and non-anterior myocardial infarction participants.
Conclusions Comparing with general hydration, the peri-operative aggressive hydration seems to be safe and effective in preventing CI-AKI among patients with STEMI undergoing pPCI.
- percutaneous coronary intervention
- myocardial infarction
- coronary angiography
Data availability statement
Data are available on reasonable request.
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YL, NT and YH contributed equally.
Contributors P-YC was the senior statistician and JC as scientific lead of GDICA provided guidance for trial management. YL, NT, YH, SC, Y-DC, PYC, JG, YX, KW, GW, KC, JY, YL, XF, SD and C-YD contributed to the design of the study. GS, FS, MD, QW, XY, HZ, MZ and YH recruited patients and collected data. SC and JL did the statistical analyses. YL, JL and ZG wrote the first draft of the manuscript. All authors contributed to interpretation of the data, revision of the report and approved the final manuscript.
Funding The ATTEMPT study was funded by the Beijing Lisheng Cardiovascular Health Foundation and the Guangdong Provincial People’s Hospital Foundation (LHJJ20141751, 2014dzx02), National Science Foundation of China (grant no. 81670339 and 81500520), Guangdong Provincial Clinical Research Center for Cardiovascular disease (2020B1111170011) and Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention (2017B030314041). The funders were not involved in trial design, patient recruitment, data collection, analysis, interpretation or presentation, writing or editing of the reports or the decision to submit for publication. The corresponding author had full access to all data in the study and had final responsibility for the decision to submit for publication.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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