title: Is atrial fibrillation a risk factor for contrast-induced nephropathy in patients with ST-elevation myocardial infarction?
abstract: BACKGROUND
  Contrast-induced nephropathy (CIN) is an iatrogenic problem in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Atrial fibrillation (AF) may also contribute to impaired kidney function. Several factors may contribute to the development of CIN. In patients with STEMI, concomitant AF is associated with higher in-hospital/follow-up mortality and morbidity. Therefore, we aimed to investigate the relationship between AF and CIN developments.
  
  
  METHODS
  In this study, 650 consecutive STEMI patients treated with PPCI were enrolled. Patients with AF at admission who did not achieve a sinus rhythm during 48h after hospitalization were defined as AF patients. CIN was defined by an increase in serum creatinine by >25% or 0.5mg/dL within 72h following contrast media exposure.
  
  
  RESULTS
  Our patients were divided into two groups based on whether they had AF, and although warfarin usage was different, the other parameters were similar between the groups. When our patients were grouped according to CIN development [group 1: CIN (+), group 2: CIN (-)], creatinine levels prior to PPCI (p=0.020), estimated glomerular filtration rate (eGFR) prior to PPCI (p<0.001), left ventricular ejection fraction (LVEF) (p=0.011), AF (p<0.001), and warfarin usage (p=0.016) were different between the two groups. We also performed multivariate logistic regression analyses and found that AF [odds ratio (OR), 6.945; 95% confidence interval (CI), 2.789-17.293; p<0.001], eGFR (OR, 0.973; 95% CI, 0.957-0.989; p=0.001), and LVEF (OR, 0.963; 95% CI, 0.935-0.991; p=0.010) independently predicted CIN development in patients with STEMI.
  
  
  CONCLUSIONS
  The risk factors for CIN are multifactorial and identifying high-risk patients is the most important step for prevention. In addition to traditional risk factors, AF can contribute to CIN development in patients with STEMI.
authors.affiliation: Mersin State Hospital, Department of Cardiology, Mersin, Turkey. Electronic address: dr_mehmetballi@hotmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ballı
authors.affiliation: Adiyaman University, Training and Research Hospital, Department of Cardiology, Mersin, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Taşolar
authors.affiliation: Adiyaman University, Training and Research Hospital, Department of Cardiology, Mersin, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Çetin
authors.affiliation: Mersin State Hospital, Department of Cardiology, Mersin, Turkey.
authors.forename: Engin
authors.initials: E
authors.lastname: Hatem
authors.affiliation: Çukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
authors.forename: Çağlar Emre
authors.initials: ÇE
authors.lastname: Çağlıyan
authors.affiliation: Adana Numune Training and Research Hospital, Department of Cardiology, Adana, Turkey.
authors.forename: Taner
authors.initials: T
authors.lastname: Şeker
authors.affiliation: Adana Numune Training and Research Hospital, Department of Cardiology, Adana, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Çaylı
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D012307:Risk Factors; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media
keywords: Atrial fibrillation; Contrast-induced nephropathy; ST-elevation myocardial infarction