Coronary artery disease
Contrast-Induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables

https://doi.org/10.1016/j.amjcard.2004.08.056Get rights and content

We previously found that contrast-induced nephropathy (CIN) complicating percutaneous coronary intervention adversely affects patients with chronic kidney disease (CKD). Therefore, we further investigated whether the predictors and outcome of CIN after percutaneous coronary intervention differ among patients with versus without CKD. Among 7,230 consecutive patients, CIN (≥25% or ≥0.5 mg/dl increase in preprocedure serum creatinine 48 hours after the procedure) developed in 381 of 1,980 patients (19.2%) with baseline CKD (estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m2) and in 688 of 5,250 patients (13.1%) without CKD. Decreased eGFRs, periprocedural hypotension, higher contrast media volumes, lower baseline hematocrit, diabetes, pulmonary edema at presentation, intra-aortic balloon pump use, and ejection fraction <40% were the most significant predictors of CIN in patients with CKD. Apart from intra-aortic balloon pump use, predictors of CIN in patients without CKD were the same as mentioned, plus older age and type of contrast media. Regardless of baseline renal function, CIN correlated with longer in-hospital stay and higher rates of in-hospital complications and 1-year mortality compared with patients without CIN. By multivariate analysis, CIN was 1 of the most powerful predictors of 1-year mortality in patients with preexisting CKD (odds ratio 2.37, 95% confidence interval 1.63 to 3.44) or preserved eGFR (odds ratio 1.78; 95% confidence interval 1.22 to 2.60). Thus, regardless of the presence of CKD, baseline characteristics and periprocedural hemodynamic parameters predict CIN, and this complication is associated with worse in-hospital and 1-year outcomes.

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Study patients

The prospectively collected Cardiovascular Research Foundation angioplasty database was queried to identify a total of 7,230 consecutive patients who underwent first percutaneous coronary intervention (angioplasty, stenting, directional atherectomy, rotablation) over a period of 5 years; we excluded patients with acute ST-elevation myocardial infarction within 48 hours, cardiogenic shock, and baseline end-stage renal disease requiring dialysis. There were 1,980 patients (27.4%) with and 5,250

Baseline and procedural characteristics

Data on patients with or without baseline CKD, according to the development of CIN, are listed in Table 1.

Among patients with CKD, those who developed CIN were older and more often had diabetes, hypertension, hyperlipidemia, peripheral vascular disease, previous myocardial infarction and/or stroke, congestive heart failure (New York Heart Association class >II) with or without pulmonary edema, moderate/severe left ventricular dysfunction (ejection fraction <40%), and non–ST-elevation myocardial

Discussion

In the present study, we extended previous observations regarding CIN in patients with CKD and documented that this complication has prognostic importance even in patients without baseline CKD. We also found that decrements of baseline eGFR value convey incrementally higher mortality. This probably indicates the presence of various stages within the same pathophysiologic spectrum; abnormal periprocedural hemodynamic parameters were strongly associated with CIN in both patient subgroups.

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