title: Comparison of risks and clinical predictors of contrast-induced nephropathy in patients undergoing emergency versus nonemergency percutaneous coronary interventions.
abstract: BACKGROUND
  Contrast nephropathy (CIN) increases adverse clinical outcomes. We examine risks and clinical predictors of CIN in patients undergoing percutaneous coronary intervention (PCI) and effectiveness of prophylactic therapy.
  
  
  METHODS
  A cohort of 8,798 patients who underwent PCI from May 2000 to April 2008 was enrolled. We divided patients into 3 groups. A: STEMI patient undergoing primary PCI; B: UA/NSTEMI patients undergoing early PCI; C: Patients without MI undergoing elective PCI. Pre-PCI saline hydration was given to group B and C if baseline glomerular filtration rate (GFR) <60 ml/min/1.73 m².
  
  
  RESULTS
  Mean age was 57.4 years; 35.9% was diabetics. Incidence of CIN were 12.0%, 9.2%, and 4.5%, in group A, B and C (P = <0.0005). CIN correlated with higher mortality (15.5% vs. 1.3%, P < 0.0005) at 1 month. The important predictors of CIN were age >70, female gender, anemia, low systolic BP < 100 mmHg, high creatinine kinase level, abnormal LVEF, baseline renal impairment, MI and insulin dependent diabetes. Incidence of CIN in patients with GFR >60 were 8.2%, 9.2%, and 4.3% in group A, B, and C respectively (p < 0.0005). Incidence of CIN in patients with GFR = 30-60 were 19.1%, 4.5%, and 2.4% (p < 0.0005) and in patients with GFR < 30 were 34.4%, 40.0%, and 25.9% (p = 0.510).
  
  
  CONCLUSIONS
  Pre-hydration prophylaxis was effective in preventing CIN in mild renal impaired patients (GFR 30-60) but are less so in more severely renal impaired patients (GFR < 30). STEMI patients undergoing primary PCI regardless of baseline GFR were at high risk. Accelerated prophylactic regime can be considered in this cohort.
authors.affiliation: Cardiac Department, National University Heart Center, Alexandra Hospital, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore. ericchong80@hotmail.com
authors.forename: Eric
authors.initials: E
authors.lastname: Chong
authors.forename: Kian K
authors.initials: KK
authors.lastname: Poh
authors.forename: Shen
authors.initials: S
authors.lastname: Liang
authors.forename: Chao Y
authors.initials: CY
authors.lastname: Soon
authors.forename: Huay-Cheem
authors.initials: HC
authors.lastname: Tan
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D016001:Confidence Intervals; D003287:Contrast Media / Q000009:adverse effects*; D004632:Emergency Medical Services; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012846:Singapore; D012965:Sodium Chloride / Q000627:therapeutic use; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D016166:Free Radical Scavengers; D012965:Sodium Chloride; D000111:Acetylcysteine