title: [Impact of plasma homocysteinemia on contrast-induced nephropathy after percutaneous coronary intervention in patients with coronary syndrome].
abstract: OBJECTIVE
  To explore the impact of plasma homocysteinemia(Hcy) on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients.
  
  
  METHODS
  Consecutive 684 ACS patients undergoing first PCI in our department between January 2013 and December 2014 were prospectively enrolled.Patients were divided into 2 groups according to the pre-procedural plasma Hcy level: high-Hcy group (Hcy≥10 μmol/L, n=404) and control group (Hcy<10 μmol/L, n=280). The CIN was defined as serum creatinine ≥ 44.2 μmol/L or 25% increase compared to baseline within 48-72 h after PCI.The baseline clinical data and the ratio of CIN were compared between the 2 groups.Multivariate logistic regression analysis was used to define the independent risk factors for CIN.
  
  
  RESULTS
  CIN occurred in 133(19.4%) out of 684 enrolled patients, and the incidence of CIN was significantly higher in high Hcy group than in the control group (22.0%(89/404)vs. 15.7%(44/280), P=0.040). After adjusting the confounding factors, including age, acute myocardial infarction, co-morbidities(hypertension, diabetes mellitus, and old myocardial infarction), laboratory examination (level of cystatin C and uric acid), glomerular filtration rate, left ventricular ejection fraction, angiographic and procedural characteristics (3 diseased vessels, multiple stent implantation), treatment at admission (spironolactone, digoxin), multivariate logistic regression analysis showed that high Hcy was independently associated with the development of CIN (OR=1.70, 95%CI 1.60-2.64, P=0.021).
  
  
  CONCLUSIONS
  Elevated Hcy prior PCI is an independent risk factor of CIN in ACS patients undergoing first PCI.
authors.affiliation: Department of Cardiology, Zhongda Hospital of Southeast University Medical School, Nanjing 210009, China.
authors.forename: Gaoliang
authors.initials: G
authors.lastname: Yan
authors.forename: Wenjie
authors.initials: W
authors.lastname: Kong
authors.forename: Dong
authors.initials: D
authors.lastname: Wang
authors.forename: Yong
authors.initials: Y
authors.lastname: Qiao
authors.forename: Xiang
authors.initials: X
authors.lastname: Sha
authors.forename: Tianyu
authors.initials: T
authors.lastname: Cheng
authors.forename: Hairong
authors.initials: H
authors.lastname: Zhang
authors.forename: Jiantong
authors.initials: J
authors.lastname: Hou
authors.forename: Chengchun
authors.initials: C
authors.lastname: Tang
authors.forename: Genshan
authors.initials: G
authors.lastname: Ma
mesh_terms: D054058:Acute Coronary Syndrome; D003920:Diabetes Mellitus; D005919:Glomerular Filtration Rate; D006801:Humans; D020138:Hyperhomocysteinemia; D015994:Incidence; D007674:Kidney Diseases; D009203:Myocardial Infarction; D062645:Percutaneous Coronary Intervention; D012307:Risk Factors; D016277:Ventricular Function, Left