|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2004; 44:1780-1785, doi:10.1016/j.jacc.2004.07.043 © 2004 by the American College of Cardiology Foundation |
Centro Cardiologico Monzino, I.R.C.C.S., Institute of Cardiology of the University of Milan, Milan, Italy
Manuscript received February 20, 2004; revised manuscript received July 22, 2004, accepted July 28, 2004.
* Reprint requests and correspondence: Dr. Giancarlo Marenzi, Centro Cardiologico Monzino, Via Parea 4, 20138 Milan, Italy (Email: giancarlo.marenzi{at}ccfm.it).
OBJECTIVES: The aim of this research was to assess the incidence, clinical predictors, and outcome of contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).
BACKGROUND: Contrast-induced nephropathy is associated with significant morbidity and mortality after PCI. Patients undergoing primary PCI may be at higher risk of CIN because of hemodynamic instability and unfeasibility of adequate prophylaxis.
METHODS: In 208 consecutive AMI patients undergoing primary PCI, we measured serum creatinine concentration (Cr) at baseline and each day for the following three days. Contrast-induced nephropathy was defined as a rise in Cr >0.5 mg/dl.
RESULTS: Overall, CIN occurred in 40 (19%) patients. Of the 160 patients with baseline Cr clearance 
60 ml/min, only 21 (13%) developed CIN, whereas it occurred in 19 (40%) of those with Cr clearance <60 ml/min (p < 0.0001). In multivariate analysis, age >75 years (odds ratio [OR] 5.28, 95% confidence interval [CI] 1.98 to 14.05; p = 0.0009), anterior infarction (OR 2.17, 95% CI 0.88 to 5.34; p = 0.09), time-to-reperfusion >6 h (OR 2.51, 95% CI 1.01 to 6.16; p = 0.04), contrast agent volume >300 ml (OR 2.80, 95% CI 1.17 to 6.68; p = 0.02) and use of intraaortic balloon (OR 15.51, 95% CI 4.65 to 51.64; p < 0.0001) were independent correlates of CIN. Patients developing CIN had longer hospital stay (13 ± 7 days vs. 8 ± 3 days; p < 0.001), more complicated clinical course, and significantly higher mortality rate (31% vs. 0.6%; p < 0.001).
CONCLUSIONS: Contrast-induced nephropathy frequently complicates primary PCI, even in patients with normal renal function. It is associated with higher in-hospital complication rate and mortality. Thus, preventive strategies are needed, particularly in high-risk patients.
| |||||||||
This article has been cited by other articles:
|
|
 |
|
  S. S. Waikar, K. D. Liu, and G. M. Chertow Diagnosis, Epidemiology and Outcomes of Acute Kidney Injury Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 844 - 861. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A. McCullough Contrast-Induced Acute Kidney Injury J. Am. Coll. Cardiol., April 15, 2008; 51(15): 1419 - 1428. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. K. Inrig, U. D. Patel, L. P. Briley, L. She, B. S. Gillespie, J. D. Easton, E. J. Topol, and L. A. Szczech Mortality, kidney disease and cardiac procedures following acute coronary syndrome Nephrol. Dial. Transplant., March 1, 2008; 23(3): 934 - 940. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Wilson and J. T. Willerson Myocardial Revascularization with Percutaneous Devices Card. Surg. Adult, January 1, 2008; 3(2008): 573 - 598. [Full Text]
|
|
|
|
|
|
W. K. Laskey, C. Jenkins, F. Selzer, O. C. Marroquin, R. L. Wilensky, R. Glaser, H. A. Cohen, D. R. Holmes Jr, and for the NHLBI Dynamic Registry Investigators Volume-to-Creatinine Clearance Ratio: A Pharmacokinetically Based Risk Factor for Prediction of Early Creatinine Increase After Percutaneous Coronary Intervention J. Am. Coll. Cardiol., August 14, 2007; 50(7): 584 - 590. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Recio-Mayoral, M. Chaparro, B. Prado, R. Cozar, I. Mendez, D. Banerjee, J. C. Kaski, J. Cubero, and J. M. Cruz The Reno-Protective Effect of Hydration With Sodium Bicarbonate Plus N-Acetylcysteine in Patients Undergoing Emergency Percutaneous Coronary Intervention: The RENO Study J. Am. Coll. Cardiol., March 27, 2007; 49(12): 1283 - 1288. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Schmidt, D. Pang, D. Nykamp, G. Knowlton, and H. Jia N-Acetylcysteine and Sodium Bicarbonate Versus N-Acetylcysteine and Standard Hydration for the Prevention of Radiocontrast-Induced Nephropathy Following Coronary Angiography Ann. Pharmacother., January 1, 2007; 41(1): 46 - 50. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Aguiar-Souto, S. Valero-Gonzalez, J. F. O. Dominguez, A. Wolak, C. Cafri, D. Zahger, D. C. Balderramo, E. Ritz, G. Marenzi, G. Lauri, et al. N-Acetylcysteine and Contrast-Induced Nephropathy N. Engl. J. Med., October 5, 2006; 355(14): 1497 - 1500. [Full Text] [PDF]
|
|
|
|
|
|
G. Marenzi, E. Assanelli, I. Marana, G. Lauri, J. Campodonico, M. Grazi, M. De Metrio, S. Galli, F. Fabbiocchi, P. Montorsi, et al. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N. Engl. J. Med., June 29, 2006; 354(26): 2773 - 2782. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Pannu, N. Wiebe, M. Tonelli, and for the Alberta Kidney Disease Network Prophylaxis Strategies for Contrast-Induced Nephropathy JAMA, June 21, 2006; 295(23): 2765 - 2779. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Bachorzewska-Gajewska, J. Malyszko, J. S. Malyszko, S. Dobrzycki, B. Sobkowicz, and W. Musial Estimation of glomerular filtration rate in patients with normal serum creatinine undergoing primary PCI: is it really normal? Nephrol. Dial. Transplant., June 1, 2006; 21(6): 1736 - 1738. [Full Text] [PDF]
|
|
|
|
|
|
I. Michishita and Z. Fujii A Novel Contrast Removal System From the Coronary Sinus Using an Adsorbing Column During Coronary Angiography in a Porcine Model J. Am. Coll. Cardiol., May 2, 2006; 47(9): 1866 - 1870. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Barrett and P. S. Parfrey Preventing Nephropathy Induced by Contrast Medium N. Engl. J. Med., January 26, 2006; 354(4): 379 - 386. [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Josephson, W. P. Dillon, and W. S. Smith Incidence of contrast nephropathy from cerebral CT angiography and CT perfusion imaging Neurology, May 24, 2005; 64(10): 1805 - 1806. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. W. O'Neill, S. R. Dixon, and C. L. Grines The year in interventional cardiology J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1117 - 1134. [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
