Coronary artery disease (CAD) is common in patients with chronic kidney disease (CKD). We report the case of a 53-year-old diabetic male with stage IV CKD who presented to the emergency department with unstable angina. He underwent coronary angiography utilizing bilateral radial artery access and simultaneous injection of the right-and left-coronary systems during rotational coronary angiography to identify a high-grade mid-right coronary artery lesion. The lesion was treated using intravenous ultrasound to facilitate minimal-contrast percutaneous intervention and the patient avoided hemodialysis post-procedure. This case demonstrates a novel approach to coronary angiography and percutaneous intervention in patients with CKD.
Objective: CIN is the most common non-cardiac complication following coronary angiography, however riskstratification for CIN can be cumbersome. We hypothesize that a computer-based Kidney Injury Risk Tool (KIRT) would assess contrast-induced nephropathy (CIN) risk accurately and may out-perform standard clinical estimation. Methods: This was a prospective study of all-comers undergoing coronary angiography at a single institution. KIRT is based upon an established risk model and risk factors were derived from the electronic medical records using phenotyping rules. Operator reported and KIRT-derived risk factors were compared against adjudicated ground truth obtained by a blinded investigator through chart review and accuracy of the risk model outputs were compared. Operator's assessment of risk without risk model vs. KIRT assessment were compared and analyzed (Wilcoxon-test, and Spearman's correlation). Results: A total of 132 patients consented for the study, 127 patients were included. KIRT-derived risk factors out-performed or matched the operator-reported for most riskfactors (sensitivity and specificity>0.86). KIRT output accuracy was higher than operator output: 79% vs. 76%. Mean operator-estimated CIN risk was lower than KIRT's estimate: 9% vs. 17% (P<0.001, paired Wilcoxon test), and held true for both high and low risk patients. Conclusion: KIRT has high accuracy in determining individual risk factors for CIN and identification of high-risk patients, and operator-based risk for CIN overestimated risk compared to KIRT.
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