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CLINICAL RESEARCH

Volume-to-Creatinine Clearance Ratio

A Pharmacokinetically Based Risk Factor for Prediction of Early Creatinine Increase After Percutaneous Coronary Intervention

Warren K. Laskey, MD, FACC^_*,_*, Charles Jenkins, MD^_*, Faith Selzer, PhD, Oscar C. Marroquin, MD, FACC, Robert L. Wilensky, MD, FACC, Ruchira Glaser, MD, FACC, Howard A. Cohen, MD, FACC, David R. Holmes, Jr, MD, FACC^|| for the NHLBI Dynamic Registry Investigators

^_* University of New Mexico School of Medicine, Albuquerque, New Mexico
University of Pittsburgh, Pittsburgh, Pennsylvania
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Lenox Hill Heart and Vascular Institute, New York, New York
^|| Mayo Clinic, Rochester, Minnesota.

Manuscript received January 29, 2007; revised manuscript received March 1, 2007, accepted March 28, 2007.

^_* Reprint requests and correspondence: Dr. Warren K. Laskey, Division of Cardiology, Department of Internal Medicine, University of New Mexico School of Medicine, MSC10-5550 1, University of New Mexico, Albuquerque, New Mexico 87131-0001. (Email: wlaskey{at}salud.unm.edu).

Objectives: This study sought to validate a pharmacokinetically derived measure of the risk of an early increase in serum creatinine after percutaneous coronary intervention (PCI).

Background: The ratio of the volume of contrast media to the creatinine clearance (V/CrCl) has been shown to correlate with the area under the curve of contrast media concentration over time.

Methods: We calculated V/CrCl in 3,179 consecutive patients undergoing PCI. An increase in serum creatinine of >0.5 mg/dl by 24 to 48 h was considered abnormal. Receiver-operator characteristic methods were used to identify the optimal sensitivity and specificity for the observed range of V/CrCl. The predictive value of V/CrCl for the risk of an early increase in creatinine was assessed using multivariable logistic regression.

Results: The overall incidence of an abnormal, early increase in creatinine was 1.5%. The mean and median values of V/CrCl for patients with (mean 5.2 ± 4.4, median 4.3, interquartile range 2.7 to 6.0) and without (mean 3.0 ± 2.0, median 2.5, interquartile range 1.7 to 3.8) an early creatinine increase were each significantly (p < 0.001) different between groups. Furthermore, there was a significant association between V/CrCl and an early increase in creatinine (overall and trend, p < 0.001). The receiver-operator characteristic curve analysis indicated that a V/CrCl ratio of 3.7 was a fair discriminator for the early creatinine increase (C-statistic 0.69). After adjusting for other known predictors of post-PCI creatinine increase, V/CrCl 3.7 remained significantly associated with an early abnormal increase in serum creatinine (odds ratio 3.84; 95% confidence interval 2.0 to 7.3, p < 0.001).

Conclusions: A V/CrCl ratio >3.7 was a significant and independent predictor of an early abnormal increase in serum creatinine after PCI in this unselected patient population.

Abbreviations and Acronyms   CAN = contrast media-associated nephrotoxicity   CrCl = creatinine clearance   PCI = percutaneous coronary intervention

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