Contrast-induced nephropathy in urgent coronary interventions.
OBJECTIVE
Patients submitted to urgent percutaneous coronary interventions (PCIs) are quite often at high risk for contrast-induced nephropathy (CIN) since they exhibit several predisposing factors such as electrical and haemodynamic instability together with the lack of time to undergo adequate prophylaxis. This was a not blinded, non-randomized study whose aims were (i) to evaluate the incidence of CIN after urgent PCI in a high-volume cardiovascular referral practice (patients with acute myocardial infarction or with acute coronary syndromes enrolled in a single centre), and (ii) to assess the prognostic implications of CIN during hospitalization and at 1-month follow-up.


METHODS
Between 1 October 2003 and 1 April 2004, 194 consecutive patients undergoing urgent coronary angiography and PCIs at our catheterization laboratory were enrolled in the study: 67 patients (34.5%) received the iso-osmolar contrast medium iodixanol (group A) and 127 patients (65.5%) received the hypo-osmolar contrast medium iopromid (group B).


RESULTS
The overall incidence of CIN was 10.82%. Patients of group A showed a higher incidence of CIN than patients of group B (22.3 vs. 4.7%, P < 0.05). On univariate logistic analysis, age, pre-existing renal insufficiency, intra-aortic balloon pump (an indirect indicator of haemodynamic instability), dyslipidaemia, and postprocedural hypotension were risk indicators for the development of CIN after primary PCI. On multivariate logistic analysis, age and postprocedural hypotension remained significant independent correlates of CIN.


CONCLUSIONS
In emergency PCIs, CIN is a frequent complication mainly related to haemodynamic instability and pre-existing renal dysfunction. Since CIN is associated with a high in-hospital mortality rate, our data stress the need for the development and validation of new preventive strategies for renal protection during emergency PCIs.
Valente
Serafina
S
Coronary Care Unit, Heart and Vessel Department, University of Florence School of Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. seravalente@hotmail.com
Lazzeri
Chiara
C
Giglioli
Cristina
C
Margheri
Massimo
M
Comeglio
Marco
M
Nicolaci
Letizia
L
Chechi
Tania
T
Gensini
Gian Franco
GF
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods; D003287:Contrast Media / Q000009:adverse effects*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007472:Iohexol / Q000009:adverse effects / Q000031:analogs & derivatives*; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D011336:Probability; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D015996:Survival Rate; D014283:Triiodobenzoic Acids / Q000009:adverse effects*
D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C038192:iopromide; C044834:iodixanol