title: [Clinical impact of nephropathy induced by contrast medium in patients with acute myocardial infarction undergoing emergent coronary angiography].
abstract: OBJECTIVE
  The incidence of contrast-induced nephropathy (CIN) after coronary angiography and the prognostic value in patients with acute myocardial infarction remains to be determined. This study investigated the frequency, predictors of CIN, and the prognostic significance of CIN in acute myocardial infarction patients undergoing emergent coronary angiography.
  
  
  METHODS
  This study included 132 consecutive acute myocardial infarction patients undergoing emergent coronary angiography within 24 hr after the onset between January 1999 and June 2001. The serum creatinine concentration was measured on admission and at 48 hr after contrast medium exposure. CIN was defined as an increase in serum creatinine from the baseline > or = 0.5 mg/dl or > or = 25% at 48 hr after emergent coronary angiography. The patient characteristics, and in-hospital and long-term mortality were compared between the CIN and non-CIN groups.
  
  
  RESULTS
  CIN occurred in 15 patients (11.4%) after emergent coronary angiography. The predictor of CIN development was preexisting renal impairment (serum creatinine concentration > or = 1.2 mg/dl on presentation; 21.9% vs 8.0%, odds ratio 3.22, 95% confidence interval 1.07-9.74, p = 0.04). In-hospital mortality was significantly higher in the CIN group than in the non-CIN group (13.3% vs 1.7%; odds ratio 8.85, 95% confidence interval 1.15-68.2, p = 0.01). The long-term mortality (mean follow-up period of 40 months) was also higher in the CIN group (26.7% vs 8.6%; hazard ratio 3.91, 95% confidence interval 1.21-12.5, p = 0.02).
  
  
  CONCLUSIONS
  CIN was an independent predictor of both in-hospital and long-term mortality in acute myocardial infarction patients undergoing emergent coronary angiography. Preexisting renal insufficiency was associated with subsequent CIN.
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Kawada-cho 8-1, Shinjuku-ku, Tokyo 162-8666. juken1123@hotmail.co.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Jujo
authors.forename: Junichi
authors.initials: J
authors.lastname: Yamaguchi
authors.forename: Kenji
authors.initials: K
authors.lastname: Obayashi
authors.forename: Kaori
authors.initials: K
authors.lastname: Suzuki
authors.forename: Haruki
authors.initials: H
authors.lastname: Sekiguchi
authors.forename: Michitaka
authors.initials: M
authors.lastname: Nagashima
authors.forename: Yukio
authors.initials: Y
authors.lastname: Tsurumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kasanuki
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007479:Iopamidol / Q000009:adverse effects*; D007674:Kidney Diseases / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D003287:Contrast Media; D003404:Creatinine; D007479:Iopamidol