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Contrast-Induced Nephropathy in STEMI Patients With and Without Chronic Kidney Disease.
Crit Pathw Cardiol 2018; 17(1):25-31CP

Abstract

INTRODUCTION

Contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) is associated with adverse outcomes; however, there are scarce data comparing clinical outcomes of post-PCI CIN in ST elevation myocardial infarction (STEMI) patients with and without chronic kidney disease (CKD). We sought to assess the incidence, clinical predictors, and short-term and long-term clinical outcomes of post-PCI CIN in STEMI patients with and without CKD.

METHODS

We performed a retrospective observational cohort study involving 554 patients who underwent PCI for STEMI from February 2010 to November 2013. CKD was defined as estimated glomerular filtration rate ≤60 mL/min and CIN as creatinine increase by ≥25% or ≥0.5 mg/dL from baseline within 72 hours after catheterization contrast exposure.

RESULTS

In the entire population, CIN developed in 89 (16%) patients. The incidence of CIN was 19.7% (27/137) in CKD patients and 11.1% (62/417) in non-CKD patients, P < 0.05. Univariate analysis predictors of CIN were older age (65 vs. 60 years), diabetes (35% vs. 21%), peripheral artery disease (11% vs. 5%), cardiogenic shock (24% vs. 13%), hemodynamic support placement (34% vs. 14%), and Mehran score (9.4 ± 7 vs. 5.4 ± 5.2) with all P < 0.05. The predictors of CIN were the same across the CKD and non-CKD cohort with the exception of diabetes. In multivariate analysis, the strongest predictor of CIN in CKD patients was diabetes (odds ratio, 5.8; CI, 1.8-18.6); however, diabetes was not a predictor in the non-CKD population. In the non-CKD population, each single unit increase in the Mehran score was associated with a 1.1 times greater likelihood of CIN (odds ratio, 1.1; CI, 1.01-1.2). Patients with CIN had higher rates of inpatient mortality (14.6% vs. 2.8%), longer length of hospitalization (8 ± 11 vs. 3.4 ± 4.4 days), need for inpatient dialysis (11.2% vs. 0%), higher 30-day mortality (14.6% vs. 3.0%), and higher incidence of long-term serum creatinine >0.5 mg/dL from baseline (16.9% vs. 2.4%) with all P < 0.05.

CONCLUSIONS

Overall, we found that CKD patients undergoing PCI for STEMI have a higher incidence of CIN than non-CKD patients. CIN confers worse short-term and long-term outcomes irrespective of baseline renal function.

Authors

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Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29432373

Citation

Jain, Tarun, et al. "Contrast-Induced Nephropathy in STEMI Patients With and Without Chronic Kidney Disease." Critical Pathways in Cardiology, vol. 17, no. 1, 2018, pp. 25-31.
Jain T, Shah S, Shah J, et al. Contrast-Induced Nephropathy in STEMI Patients With and Without Chronic Kidney Disease. Crit Pathw Cardiol. 2018;17(1):25-31.
Jain, T., Shah, S., Shah, J., Jacobsen, G., & Khandelwal, A. (2018). Contrast-Induced Nephropathy in STEMI Patients With and Without Chronic Kidney Disease. Critical Pathways in Cardiology, 17(1), pp. 25-31. doi:10.1097/HPC.0000000000000123.
Jain T, et al. Contrast-Induced Nephropathy in STEMI Patients With and Without Chronic Kidney Disease. Crit Pathw Cardiol. 2018;17(1):25-31. PubMed PMID: 29432373.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Contrast-Induced Nephropathy in STEMI Patients With and Without Chronic Kidney Disease. AU - Jain,Tarun, AU - Shah,Sunay, AU - Shah,Jainil, AU - Jacobsen,Gordon, AU - Khandelwal,Akshay, PY - 2018/2/13/entrez PY - 2018/2/13/pubmed PY - 2019/4/17/medline SP - 25 EP - 31 JF - Critical pathways in cardiology JO - Crit Pathw Cardiol VL - 17 IS - 1 N2 - INTRODUCTION: Contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) is associated with adverse outcomes; however, there are scarce data comparing clinical outcomes of post-PCI CIN in ST elevation myocardial infarction (STEMI) patients with and without chronic kidney disease (CKD). We sought to assess the incidence, clinical predictors, and short-term and long-term clinical outcomes of post-PCI CIN in STEMI patients with and without CKD. METHODS: We performed a retrospective observational cohort study involving 554 patients who underwent PCI for STEMI from February 2010 to November 2013. CKD was defined as estimated glomerular filtration rate ≤60 mL/min and CIN as creatinine increase by ≥25% or ≥0.5 mg/dL from baseline within 72 hours after catheterization contrast exposure. RESULTS: In the entire population, CIN developed in 89 (16%) patients. The incidence of CIN was 19.7% (27/137) in CKD patients and 11.1% (62/417) in non-CKD patients, P < 0.05. Univariate analysis predictors of CIN were older age (65 vs. 60 years), diabetes (35% vs. 21%), peripheral artery disease (11% vs. 5%), cardiogenic shock (24% vs. 13%), hemodynamic support placement (34% vs. 14%), and Mehran score (9.4 ± 7 vs. 5.4 ± 5.2) with all P < 0.05. The predictors of CIN were the same across the CKD and non-CKD cohort with the exception of diabetes. In multivariate analysis, the strongest predictor of CIN in CKD patients was diabetes (odds ratio, 5.8; CI, 1.8-18.6); however, diabetes was not a predictor in the non-CKD population. In the non-CKD population, each single unit increase in the Mehran score was associated with a 1.1 times greater likelihood of CIN (odds ratio, 1.1; CI, 1.01-1.2). Patients with CIN had higher rates of inpatient mortality (14.6% vs. 2.8%), longer length of hospitalization (8 ± 11 vs. 3.4 ± 4.4 days), need for inpatient dialysis (11.2% vs. 0%), higher 30-day mortality (14.6% vs. 3.0%), and higher incidence of long-term serum creatinine >0.5 mg/dL from baseline (16.9% vs. 2.4%) with all P < 0.05. CONCLUSIONS: Overall, we found that CKD patients undergoing PCI for STEMI have a higher incidence of CIN than non-CKD patients. CIN confers worse short-term and long-term outcomes irrespective of baseline renal function. SN - 1535-2811 UR - https://www.unboundmedicine.com/medline/citation/29432373/Contrast_Induced_Nephropathy_in_STEMI_Patients_With_and_Without_Chronic_Kidney_Disease_ L2 - http://dx.doi.org/10.1097/HPC.0000000000000123 DB - PRIME DP - Unbound Medicine ER -