Coronary artery diseaseA Comparison of Contemporary Definitions of Contrast Nephropathy in Patients Undergoing Percutaneous Coronary Intervention and a Proposal for a Novel Nephropathy Grading System
Section snippets
Methods
We prospectively collected baseline clinical, angiographic, and in-hospital outcome (death, infarction after PCI or reinfarction, and target vessel revascularization) data in all patients undergoing PCI at the Guthrie Clinic/Robert Packer Hospital. Measurement of serum creatinine before PCI and the day after PCI is strongly encouraged. Subsequent measurements of serum creatinine during hospital stay are recommended, especially if an increase in serum creatinine is noted on the day after PCI or
Results
Clinical characteristics are listed in Table 1. Baseline renal insufficiency was seen in 25% and positive biomarkers in 48%. Incidence of CIN by each of the 4 definitions, in all patients, selected high-risk subgroups, and low-risk subgroup, is presented in Table 2. The incidence of CIN varied widely, from 2.0% (using the ACC-NCDR definition) to 15.0% (using the δCr >25% definition) in the study population. High-risk subsets, such as age >65 years, diabetes mellitus, abnormal cardiac biomarkers
Discussion
In patients undergoing PCI, the incidence of CIN varies widely depending on the definition used. Of the 4 contemporary definitions, only 2 (δCr >0.5 mg/dl and >25%) consistently predicted clinical outcomes. Compared with δCr >25%, the δCr >0.5 mg/dl definition provides greater discrimination between unselected patients and patients at high risk for CIN and is a more robust indicator of poor outcomes. Based on these findings, we propose a novel nephropathy grading system that unifies the δCr
Acknowledgment
We acknowledge the assistance of Sue Tomaszycki with the figures.
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