Frequency and predictors of contrast-induced nephropathy after angioplasty for chronic total occlusions.
BACKGROUND
The incidence and predictors of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) have not been specifically reported.


METHODS
This retrospective analysis included all consecutive patients referred for PCI of CTO between April 2003 and March 2008, with baseline and 24 h postprocedural available creatinine levels. CIN was defined as 24 h postprocedural increase of baseline creatinine levels > or =0.5 mg/dl (CIN(05)) or > or =25% (CIN(25)). Severe renal dysfunction (SRD) was defined as acute renal failure requiring dialysis, or an increase in baseline creatinine levels > or =2.0 mg/dl (SRD(2)) or > or =50% (SRD%). Patients were classified into risk categories for CIN, according to the validated Mehran risk score.


RESULTS
A total of 227 patients were included, mean age of 64+/-10 years, the majority being at low risk for CIN (55% with < or =5 points in the Mehran score). CIN(25) occurred in 6.16% (14/227) patients and CIN(05) in 0.88% (2/227). The incidence of SRD(2) or SDR% was 0% (0/227) and 0.9% (2/227), respectively, with no patient requiring dialysis. Patients who developed CIN(25) received a higher contrast volume than those who did not (312 ml (210-400) vs 260 ml (200-345), p=0.14), but the difference was not statistically significant.


CONCLUSIONS
In this consecutive cohort of patients, the incidence of CIN following PCI for CTO was low despite the administration of moderate to large volumes of contrast media. Attempts at revascularization of CTO should not be discouraged or be prematurely interrupted because of the fear of CIN.
Aguiar-Souto
Pablo
P
Department of Cardiology, Royal Brompton Hospital, London, UK.
Ferrante
Giuseppe
G
Del Furia
Francesca
F
Barlis
Peter
P
Khurana
Rohit
R
Di Mario
Carlo
C
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000706:statistics & numerical data; D002908:Chronic Disease; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors
D003287:Contrast Media; D003404:Creatinine