The incidence of CIN in high risk patients undergoing PCI is substantially higher in our population compared to similar studies in the west. The MRS risk prediction is pertinent even in an Indian population.

ObjectivesTo study if four cycles of remote ischemic preconditioning (RIPC) could offer protection against contrast induced nephropathy (CIN) and post procedural renal dysfunction in high risk patients undergoing percutaneous coronary intervention (PCI).MethodsThis was a prospective single blind randomized sham controlled trial where patients undergoing coronary angioplasty with stage III chronic kidney disease were randomized into sham preconditioning and remote ischemic preconditioning. The primary outcome was the reduction in the incidence of CIN. The secondary outcomes were the maximum improvement in eGFR, maximum reduction in serum creatinine and composite of requirement of hemodialysis, death and rehospitalization for heart failure up to 6 weeks after PCI.ResultsEleven out of fifty patients in the study group developed CIN (22%) compared to eighteen out of the fifty control patients (36%) (p = 0.123). There was a statistically significant improvement in the post procedure creatinine values at 24 h (p = 0.013), 48 h (p = 0.015), 2 weeks (p = 0.003), 6 weeks (p = 0.003) and post procedure glomerular filtration rate (eGFR) values at 24 h (p = 0.026), 48 h (p = 0.044), 2 weeks (p = 0.015) and 6 weeks (p = 0.011) in study group compared to control group. The secondary outcome composite of requirement of hemodialysis, death and rehospitalization for heart failure was not statistically significant (p: 0.646).ConclusionRIPC does not result in significant reduction of CIN. However RIPC helps in the prevention of post procedural worsening in eGFR and serum creatinine even up to 6 weeks.

BACKGROUND Gamma glutamyl transferase (GGT) is a biomarker elevated in various cardiovascular diseases due to oxidation mediated free radical damage. It has been recently used in patients presenting with acute coronary syndromes (ACS) for predicting major adverse cardiovascular events and in hospital adverse outcomes. The application of gamma glutamyl transferase to the traditional set of biomarkers like troponin I and T, creatinine kinase-MB (CKMB) adds to the value that it helps in reclassifying the patients into high and low risk and plan the appropriate treatment strategy. METHODS Patients presenting with acute coronary syndromes were classified into STEMI (ST elevation myocardial infarction), NSTEMI (Non-ST elevation myocardial infarction) and unstable angina based on cardiac biomarkers and electrocardiographic changes. Serum gamma glutamyl transferase of these patients were measured by photo spectrometry and were monitored for 5 days for major adverse cardiovascular events. RESULTS Of the study population (N = 210), 41 % presented with STEMI, 24 % unstable angina, 25 % NSTEMI. The normal range of GGT in our study population was 15 - 70 U/l. values more than 70 U/l was considered raised GGT major adverse cardiac events (MACE) was present in 35 % of the study population. 58 % of the patients with MACE had raised GGT (> 70 U/l) which was statistically significant (P < 0.001). The ROC (receiver operator characteristic curve) for GGT to predict MACE was to the left of the reference line and the area under the curve (AUC) was 0.915. The optimal cut-off for GGT to predict MACE from our study was 50.5 with a sensitivity and specificity of 0.813 and 0.868 respectively. CONCLUSIONS Raised GGT was significantly associated with MACE and in hospital adverse outcomes (ventricular arrythmias, heart failure, recurrent angina). GGT can be used as a prognostic marker in patients presenting with ACS. KEYWORDS Gamma Glutamyl Transferase, Acute Coronary Syndromes, St Elevation Myocardial Infarction, Non-ST Elevation Myocardial Infarction, Unstable Angina