1D.10: PREDICTORS AND OUTCOMES OF CONTRAST-INDUCED ACUTE KIDNEY INJURY IN PATIENTS WITH PRIMARY PERCUTANEOUS INTERVENTION. (June 2015)

• Record Type: Journal Article
• Authors: Gaskina, A.; Villevalde, S.; Kobalava, Z.
• Is Part Of: Journal of hypertension. Volume 33(2015)Supplement 1
• Publication Date: 2015-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000467396.51345.af
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: The incidence of contrast-induced acute kidney injury (CI-AKI) is rising due to increased use of coronary angiography and percutaneous coronary intervention (PCI). Patients undergoing primary PCI are at high risk of CI-AKI, a complication that negatively affects outcomes. The aim of the study was to evaluate the incidence, predictors and outcomes of CI-AKI in patients with ST-segment elevation myocardial infarction (STEMI) and primary PCI. Design and method: 216 patients with STEMI and primary PCI (143 male, 64 ± 13 years (M ± SD), arterial hypertension 90%, previous myocardial infarction 27%, diabetes mellitus 21%, known chronic kidney disease 7%, anemia 14%, heart failure 62%, left ventricular ejection fraction (LV EF) 44 ± 15%) were examined. CI-AKI was defined using 2012 KDIGO Guidelines. Mann-Whitney test was performed. P < 0.05 was considered statistically significant. Results: 20% of patients developed CI-AKI. Stages 1 and 2 of CI-AKI were found in 77 and 33% of cases accordingly. CI-AKI developed in 66% of cases in first 48 hours after PCI. Patients with versus without CI-AKI were older (69 ± 13 vs 63 ± 12 years, p < 0.05), had higher baseline serum creatinine (104 ± 31 vs 87 ± 22 μmol/l, p < 0.001), lower LV EF (37 ± 10 vs 41 ± 14%, p < 0.05), higher rate of CKD (21 vs 3.5%, p < 0.001) and higher rate of therapy with nephrotoxic antibiotics (19 vs 3.5%, p < 0.05), loop diuretics (72 vs 39%, p < 0.05), mineralocorticoid receptor antagonists (56 vs 37%, p < 0.05), higher contrast volume (CV) (282 ± 94 vs 236 ± 85 ml, p < 0.05), contrast media volume/estimated glomerular filtration rate ratio (CV/eGFR) (4, 02 ± 2, 15 vs 2, 32 ± 1, 08, p < 0.05), higher rate of multivessel coronary damage (84 vs 59%, p < 0.05). Patients with CI-AKI had higher risk of 30-days mortality (10 vs 3%, p < 0.05) and similar rate of 6 months rehospitalizations (66 vs 46%, p > 0.05). Conclusions: CI-AKI in patients with STEMI and primary PCI developed in 20% of cases, predominantly in first 48 hours after PCI. CI-AKI was associated with higher rate of CKD, therapy with nephrotoxic drugs, multivessel coronary damage, higher baseline serum creatinine, CV/eGFR. CI-AKI had negative impact on 30-days mortality.