Incidence, predictors and outcomes of contrast-induced acute kidney injury in patients with acute coronary syndrome and percutaneous intervention
AbstractAim. Contrast-induced acute kidney injury (CI-AKI) is a well-known serious complication of percutaneous coronary intervention (PCI) associated with increased morbidity and mortality. The aim of the study was to evaluate the incidence, predictors and outcomes of CI-AKI in patients with acute coronary syndrome (unstable angina pectoris/non-ST-segment elevation myocardial infarction (UAP/NSTEMI) and ST-segment elevation myocardial infarction (STEMI) with delayed and primary PCI.
Methods. 236 patients with UAP/NSTEMI and delayed PCI (65Ѓ}12 years, arterial hypertension 94%, previous MI 42%, diabetes mellitus (DM) 24%, known chronic kidney disease 15%) were examined. CI-AKI was defined using 2012 KDIGO Guidelines. Mann–Whitney test and multivariate logistic regression analysis were performed, p<0,05 was considered statistically significant.
Results. 15% of patients with UAP/NSTEMI and delayed PCI developed CI-AKI, stages 1 and 2 of CI-AKI were found in 71 and 29% of cases accordingly. 20% of patients with STEMI and primary PCI developed CI-AKI, stages 1 and 2 of CI-AKI were found in 81 and 19% of cases accordingly. Main independent predictors of patients with UAP/NSTEMI and delayed PCI of CI-AKI (in decreasing order of importance) were therapy with nephrotoxic antibiotics, main left coronary artery disease, troponin ≥1,73 ng/ml, age ≥69,5 years, stroke, leukocytes ≥9,35×106/l, baseline GFR ≤67 ml/min/1,73 m2, DM, anemia, high/very higher risk of developing CI-AKI (>10 points on a scale R. Mehran), female gender. Main independent predictors of patients with STEMI and primary PCI of CI-AKI (in decreasing order of importance) were contrast media volume/estimated glomerular filtration rate ratio (CV/eGFR) ≥5,3, CKD, therapy with nephrotoxic antibiotics, baseline eGFR ≤56,6 ml/min/1,73 m2, loop diuretics, multivessel coronary damage, LV EF ≤39,5%, contrast volume (CV) ≥250 ml, baseline serum creatinine ≥114 μmol/l, age ≥65,5 years, mineralocorticoid receptor antagonists. Patients with UAP/NSTEMI and delayed PCI with CI-AKI had higher risk of hospital mortality (16,7 vs 1,6%), 30-days mortality (12 vs 4%) and 6 months rehospitalizations (74 vs 58%). Patients with STEMI and primary PCI with CI-AKI had higher risk of 30-days mortality (10 vs 3%, p<0,05) and similar rate of 6 months rehospitalizations (66 vs 46%, p<0,05).
Keywords:contrastinduced acute kidney injury, acute coronary syndrome, delayed percutaneous coronary intervention, primary percutaneous coronary intervention