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PERCUTANEOUS INTERVENTION AND RENAL DYSFUNCTION

Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction

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.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CCU = coronary care unit   CI = confidence interval   CIN = contrast-induced nephropathy   Cr = serum creatinine concentration   OR = odds ratio   PCI = percutaneous coronary intervention

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