Risk factors and clinical outcomes for contrast-induced nephropathy after percutaneous coronary intervention in patients with normal serum creatinine.
BACKGROUND
We aim to examine the risk predictors of contrast-induced nephropathy (CIN) in patients with normal baseline serum creatinine (Cr). CIN is an important complication postpercutaneous coronary intervention (PCI). Previous studies examined CIN predictors in patients with chronic renal impairment. No large studies investigated patients with normal renal function which constitute the majority undergoing PCI. We aim to identify risk predictors in this cohort and examine the clinical outcomes.


METHODS
A total of 3036 patients with normal baseline Cr (<1.5 mg/dL) who did not receive prophylaxis while undergoing PCI were enrolled. We examined the occurrence of CIN and the mortality outcome at 1 and 6 months.


RESULTS
CIN occurred in 7.3% of patients. The median age was 59.5 years (range, 26 to 86), 78.7% men, 34.6% diabetics. Risk predictors for CIN include age [odds ratio (OR), 6.4; 95% CI, 1.01-13.3; P = 0.042], female gender (OR, 2.0; 95% CI, 1.5-2.7; P = 0.001), abnormal left ventricular ejection fraction (LVEF) <50%(OR,1.02; 95% CI, 1.01-1.04; P = 0.01), anaemia with haemoglobin <11 mg/dL (OR, 1.5; 95% CI, 1.01-2.4; P = 0.044) and systolic hypotension with blood pressure <100 mmHg (OR, 1.5; 95% CI, 1.01-2.2; P = 0.004). Diabetics on insulin therapy were at the highest risk compared with diabetics on oral hypoglycaemics and diet control (18.9% vs 6.8% vs 3.6%; P = 0.001). Patients who developed CIN had higher mortality at 1 month (14.5% vs 1.1%; P <0.001) and 6 months (17.8% vs 2.2%; P <0.001).


CONCLUSIONS
Subgroups of patients with normal baseline Cr undergoing PCI are at risk of developing CIN with resultant higher mortality. Age, female gender, insulin dependent diabetes mellitus, presence of hypotension, anaemia and low LVEF are predictors of CIN. Prophylaxis may be considered in these patients.
Chong
Eric
E
Alexandra Hospital Cardiac Department; National University Heart Centre, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. ericchong80@hotmail.com
Poh
Kian Keong
KK
Liang
Shen
S
Tan
Huay Cheem
HC
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood*; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007022:Hypotension; D007674:Kidney Diseases / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left
D003287:Contrast Media; D003404:Creatinine