Advertisement





Click here for more guidelines.
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2004; 44:1780-1785, doi:10.1016/j.jacc.2004.07.043
© 2004 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Marenzi, G.
Right arrow Articles by Bartorelli, A. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Marenzi, G.
Right arrow Articles by Bartorelli, A. L.

PERCUTANEOUS INTERVENTION AND RENAL DYSFUNCTION

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

Giancarlo Marenzi, MD*, Gianfranco Lauri, MD, Emilio Assanelli, MD, Jeness Campodonico, MD, Monica De Metrio, MD, Ivana Marana, MD, Marco Grazi, MD, Fabrizio Veglia, PhD and Antonio L. Bartorelli, MD, FACC

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




This article has been cited by other articles:


Home page
ANN INTERN MEDHome page
G. Marenzi, E. Assanelli, J. Campodonico, G. Lauri, I. Marana, M. De Metrio, M. Moltrasio, M. Grazi, M. Rubino, F. Veglia, et al.
Contrast Volume During Primary Percutaneous Coronary Intervention and Subsequent Contrast-Induced Nephropathy and Mortality
Ann Intern Med, February 3, 2009; 150(3): 170 - 177.
[Abstract] [Full Text] [PDF]


Home page
RadiologyHome page
M. C. Heinrich, L. Haberle, V. Muller, W. Bautz, and M. Uder
Nephrotoxicity of Iso-osmolar Iodixanol Compared with Nonionic Low-osmolar Contrast Media: Meta-analysis of Randomized Controlled Trials
Radiology, January 1, 2009; 250(1): 68 - 86.
[Abstract] [Full Text] [PDF]


Home page
CJASNHome page
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]


Home page
J Am Coll CardiolHome page
P. A. McCullough
Contrast-Induced Acute Kidney Injury
J. Am. Coll. Cardiol., April 15, 2008; 51(15): 1419 - 1428.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
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]


Home page
Card Surg AdultHome page
J. M. Wilson and J. T. Willerson
Myocardial Revascularization with Percutaneous Devices
Card. Surg. Adult, January 1, 2008; 3(2008): 573 - 598.
[Full Text]


Home page
J Am Coll CardiolHome page
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]


Home page
J Am Coll CardiolHome page
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]


Home page
The Annals of PharmacotherapyHome page
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]


Home page
NEJMHome page
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]


Home page
NEJMHome page
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]


Home page
JAMAHome page
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]


Home page
Nephrol Dial TransplantHome page
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]


Home page
J Am Coll CardiolHome page
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]


Home page
NEJMHome page
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]


Home page
NeurologyHome page
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]


Home page
J Am Coll CardiolHome page
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]



 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement