Acute contrast nephropathy after coronary intervention: Incidence, risk factors, and relationship to mortality

McCullough, Peter A.; Wolyn, Robert; Rocher, Leslie L.; Levin, Robert N.; O’Neill, William W.

doi:10.1016/s0735-1097(96)82116-4

Cited by 534 publications

(937 citation statements)

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“…Presently, our study is the only prospective trial that provides data on the long-term outcome of patients with and without CIN. This is of considerable clinical relevance because the reported CIN-associated in-hospital and long-term mortality rates appear to be very high (2,3,5,6,15,16,18), while longterm data concerning this aspect are rare and have been derived only from small retrospective studies (2,3,5,6).…”

Section: Discussionmentioning

confidence: 99%

“…The incidence depended on the definition of CIN and the patient cohort studied. The development of CIN was associated with markedly poor in-hospital and long-term prognosis, with mortality rates found varying from 10% to 38% at one year in small, retrospective studies (2,5) to 81% at two years (6). There are currently an estimated 50 million procedures using iodinated contrast media performed worldwide each year (7), and radiographic contrast media are increasingly being used with recent progress in diagnostic noninvasive and invasive imaging techniques.…”

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confidence: 99%

“…An increasing number of trials have addressed the prevention and confounding factors of CIN (2,4,6,8,9). However, there has been no prospective trial that provided data on the predictors of CIN and longterm survival of affected patients.…”

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confidence: 99%

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Predictors for contrast media-induced nephropathy and long-term survival: Prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial

Hölscher¹,

Heitmeyer²,

Fobker³

et al. 2008

Canadian Journal of Cardiology

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T he development of radiographic contrast media originated from the use of sodium iodide in radiography in 1918 (1), when Walter Dandy directly injected contrast media into the cerebral ventricles for visualizing the outline of the brain and the ventricular system. Since then, many different types of contrast media have been synthesized, and many improvements in terms of side effects, such as hypersensitivity reactions, have been made. Moreover, associated acute renal failure, currently classified as contrast media-induced nephropathy (CIN), remains a major complication in hospitalized patients undergoing diagnostic or therapeutic interventional procedures using CLINICAL STUDIES ©2008 Pulsus Group Inc. All rights reserved BACKGROUND: Among the numerous studies concerning contrast media-induced nephropathy (CIN), there was no prospective trial that provided data on the long-term outcomes. OBJECTIVES: To prospectively assess predictors of CIN and long-term outcomes of affected patients. METHODS: Four hundred twelve consecutive patients with serum creatinine levels of 115 μmol/L to 309 μmol/L (1.3 mg/dL to 3.5 mg/dL) undergoing elective coronary angiography were included. Patients were randomly assigned to periprocedural hydration alone, hydration plus onetime hemodialysis or hydration plus N-acetylcysteine. RESULTS: Multivariate logistic regression identified the following as predictors of CIN within 72 h (equivalent to an increase in creatinine 44.2 μmol/L [0.5 mg/dL] or more) : prophylactic postprocedural hemodialysis (OR 2.86, 95% CI 1.07 to 7.69), use of angiotensin-converting enzyme inhibitors (OR 6.16, 95% CI 2.01 to 18.93), baseline glomerular filtration rate (OR 0.94, 95% CI 0.90 to 0.98) and the amount of contrast media given (OR 1.01, 95% CI 1.00 to 1.01). With regard to long-term outcome (mean follow-up 649 days), multivariate Cox regression models found elevated creatinine levels at 30 days (hazard rate ratio [HRR] 5.48, 95% CI 2.85 to 10.53), but not CIN within 72 h (HRR 1.12, 95% CI 0.63 to 2.02), to be associated with increased mortality. In addition, independent predictors for death during follow-up included left ventricular ejection fraction lower than 35% (HRR 4.01, 95% CI 2.22 to 7.26), serum phosphate (HRR 1.64, 95% CI 1.10 to 2.43) and hemoglobin (HRR 0.80, 95% CI 0.67 to 0.96). CONCLUSION: From the present prospective trial, performance of postprocedural hemodialysis, use of angiotensin-converting enzyme inhibitors, reduced baseline glomerular filtration rate and amount of contrast media were independent predictors of CIN within 72 h after catheterization. Assessing renal function after 30 days, rather than within 72 h, seemed to be more predictive for patients' long-term survival.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Predictors for contrast media-induced nephropathy and long-term survival: Prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial

Hölscher¹,

Heitmeyer²,

Fobker³

et al. 2008

Canadian Journal of Cardiology

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“…Among patients with cardiogenic shock, one-stage multivessel PCI was associated with worse outcomes compared with single-vessel culprit PCI [101] and was associated with more complications than culprit stenosis PCI followed by delayed nonculprit stenosis PCI [106,107]. Culprit stenosis PCI with subsequent PCI of additional important stenoses during the same hospitalization has been recommended as the best strategy in patients with cardiogenic shock [102].…”

Section: Cardiogenic Shockmentioning

confidence: 99%

“…Contrast doses <100 cm 3 rarely cause CIN [107] in patients with normal or mildly impaired renal function, but the incidence of CIN increases by 14% for each 50 cm 3 increase in contrast volume [108], and contrast doses over 260 cm 3 particularly predispose patients to CIN [109].…”

Section: Procedural Considerations Managing Radiographic Contrastmentioning

confidence: 99%

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

Blankenship

Moussa

Chambers

et al. 2011

Cathet Cardio Intervent

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Percutaneous coronary interventions (PCIs) to treat multivessel coronary artery disease (MVCAD) may involve single-vessel or multivessel interventions, performed in one or more stages. This consensus statement reviews factors that may influence choice of strategy and includes six recommendations to guide decisions regarding staging of PCI [1]. Every patient who undergoes PCI should receive optimal therapy for coronary disease, ideally before starting the procedure [2]. Multivessel PCI at the time of diagnostic catheterization should be considered only if informed consent included the risks and benefits of multivessel PCI and the risks and benefits of alternative treatments [3]. When considering multivessel PCI, the interventionist should develop a strategy regarding which stenoses to treat or evaluate, and their order, method, and timing. This strategy should maximize patient benefits, minimize patient risk, and consider the factors described in this article [4]. For planned multivessel PCI, additional vessel(s) should be treated only if the first vessel is treated successfully and if anticipated contrast and radiation doses and patient and operator conditions are favorable [5]. After the first stage of the planned multistage PCI, the need for subsequent PCI should be reviewed before it is performed [6]. Third party payers and quality auditors should recognize that multistage PCI for MVCAD is neither an indication of poor quality nor an attempt to increase reimbursement when performed according to recommendations in this article.V C 2011 Wiley Periodicals, Inc.

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Prevention of Contrast Media–Associated Nephropathy

Müeller¹,

Buerkle²,

Buettner³

et al. 2002

Arch Intern Med

723

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Acute contrast nephropathy after coronary intervention: Incidence, risk factors, and relationship to mortality

Cited by 534 publications

References 0 publications

Predictors for contrast media-induced nephropathy and long-term survival: Prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial

Predictors for contrast media-induced nephropathy and long-term survival: Prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

Prevention of Contrast Media–Associated Nephropathy

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