Acute hyperglycemia and contrast-induced nephropathy in primary percutaneous coronary intervention

Marenzi, Giancarlo; Metrio, Monica De; Rubino, Mara; Lauri, Gianfranco; Cavallero, Annalisa; Assanelli, Emilio; Grazi, Marco; Moltrasio, Marco; Marana, Ivana; Campodonico, Jeness; Discacciati, Andrea; Veglia, Fabrizio; Bartorelli, Antonio L.

doi:10.1016/j.ahj.2010.09.022

Cited by 93 publications

(90 citation statements)

References 32 publications

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“…More recently, Marenzi and co-workers also showed similar results in patients undergoing primary PCI for ST-segment elevation myocardial infarction. 18 However, we observed that the pre-procedural glucose level was closely associated with a risk for CI-AKI in both diabetic and non-diabetic patients. The causes for the discordant result in diabetic patients are unclear.…”

Section: Discussionmentioning

confidence: 53%

“…10- 16 Some recent clinical studies have suggested that the pre-procedural glucose level might be a potential and independent risk factor for the development of CI-AKI in patients undergoing coronary angiography for AMI 17 and in patients undergoing primary PCI for ST-segment elevation myocardial infarction. 18 However, the relationship between the pre-C Hyperglycemia and AKI in Emergency PCI for ACS procedural glucose level and the risk of CI-AKI has not yet been well examined in patients with acute coronary syndrome (ACS), especially in those with diabetes.…”

Section: Ontrast-induced Acute Kidney Injury (Ci-aki) Resultsmentioning

confidence: 99%

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Pre-Procedural Glucose Levels and the Risk for Contrast-Induced Acute Kidney Injury in Patients Undergoing Emergency Coronary Intervention

Naruse

Ishii

Hashimoto

et al. 2012

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ontrast-induced acute kidney injury (CI-AKI) results from acute tubular necrosis from nephrotoxic iodinated contrast agent administered intra-arterially during a procedure as well as from other homeostatic factors. 1-3 Contrast volume is a key risk factor for CI-AKI and is most crucial in high-risk patients. 3-6Previous studies have demonstrated that the risk of CI-AKI is markedly increased if contrast volume exceeds the weightand creatinine level-adjusted maximum allowable contrast dose (MACD) threshold. 3,7-9 A recent large prospective clinical trial (n=10,065) has shown that exceeding MACD in a patient undergoing percutaneous coronary intervention (PCI) is associated with an increased risk of CI-AKI by 45% for each 50% in excess of MACD, whereas contrast volumes below the threshold hold to a lower plateau risk of CI-AKI. 3 However, CI-AKI remains an adverse outcome for patients even when contrast volume does not exceed MACD. Furthermore, MACD is not exceeded in approximately 80% of the patients undergoing PCI. 3 Thus, it is important to design studies focusing on CI-AKI in patients when contrast volume does not exceed MACD.Elevated blood glucose levels occur commonly in patients with acute myocardial infarction (AMI), and are strongly associated with increased mortality and in-hospital complications. 10-16 Some recent clinical studies have suggested that the pre-procedural glucose level might be a potential and independent risk factor for the development of CI-AKI in patients undergoing coronary angiography for AMI 17 and in patients undergoing primary PCI for ST-segment elevation myocardial infarction. 18 However, the relationship between the pre- The incidence, risk factors, and outcome of contrast-induced acute kidney injury (CI-AKI) in 730 patients with acute coronary syndrome (ACS) undergoing emergency percutaneous coronary intervention (PCI), whose contrast volume was below maximum allowable contrast dose (MACD) was prospectively investigated.

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Section: Discussionmentioning

confidence: 53%

Section: Ontrast-induced Acute Kidney Injury (Ci-aki) Resultsmentioning

confidence: 99%

Pre-Procedural Glucose Levels and the Risk for Contrast-Induced Acute Kidney Injury in Patients Undergoing Emergency Coronary Intervention

Naruse

Ishii

Hashimoto

et al. 2012

Circ J

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“…Again, the relationship between acute hyperglycemia and AKI risk has been reported to be markedly different among patients with and without DM, with non‐DM patients showing higher relative risk of AKI at each given blood glucose level 11. Consequently, a knowledge gap still exists regarding the connection between elevated glucose levels and AKI risk in DM patients with AMI.…”

Section: Discussionmentioning

confidence: 99%

“…A diagnosis of unknown DM was made when patients had ≥6.5% (48 mmol/mol) HbA 1c despite no previous history of the disease 13. Acute hyperglycemia was defined as a blood glucose level at admission >198 mg/dL (>11 mmol/L), according to the definition used in previous studies focusing on AMI patients 11, 14, 15, 16. Average chronic glucose levels were estimated by HbA 1c , expressed as percentage value, according to the following validated formula12, 13, 17:

Estimated chronic glucose levels false(mg false/ dL false) = 28.7 \times {HbA}_{1 c} false(% false) - 46.7

…”

Section: Methodsmentioning

confidence: 99%

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Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia

Marenzi

Cosentino

Milazzo

et al. 2018

JAHA

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BackgroundIn acute myocardial infarction, acute hyperglycemia is a predictor of acute kidney injury (AKI), particularly in patients without diabetes mellitus. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission. We investigated whether, in diabetic patients with acute myocardial infarction, the combined evaluation of acute and chronic glycemic levels may have better prognostic value for AKI than admission glycemia.Methods and ResultsAt admission, we prospectively measured glycemia and estimated average chronic glucose levels (mg/dL) using glycosylated hemoglobin (HbA1c), according to the following formula: 28.7×HbA1c (%)−46.7. We evaluated the association with AKI of the acute/chronic glycemic ratio and of the difference between acute and chronic glycemia (ΔA−C). We enrolled 474 diabetic patients with acute myocardial infarction. Of them, 77 (16%) experienced AKI. The incidence of AKI increased in parallel with the acute/chronic glycemic ratio (12%, 14%, 22%; P=0.02 for trend) and ΔA−C (13%, 13%, 23%; P=0.01) but not with admission glycemic tertiles (P=0.22). At receiver operating characteristic analysis, the acute/chronic glycemic ratio (area under the curve: 0.62 [95% confidence interval, 0.55–0.69]; P=0.001) and ΔA−C (area under the curve: 0.62 [95% confidence interval, 0.54–0.69]; P=0.002) accurately predicted AKI, without difference in the area under the curve between them (P=0.53). At reclassification analysis, the addition of the acute/chronic glycemic ratio and ΔA−C to acute glycemia allowed proper AKI risk prediction in 16% of patients.ConclusionsIn diabetic patients with acute myocardial infarction, AKI is better predicted by the combined evaluation of acute and chronic glycemic values than by assessment of admission glycemia alone.

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Impact of short term oral steroid use for intravenous contrast media hypersensitivity prophylaxis in diabetic patients undergoing nonemergent coronary angiography or interventions

Amr

Lippmann

Tobbia

et al. 2019

Cathet Cardio Intervent

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Objectives: Oral steroids are routinely administered in the United States for prophylaxis of iodinated contrast media hypersensitivity (ICMH). We studied the impact of short-term steroid use in diabetic patients with ICMH undergoing nonemergent coronary angiography. Methods: We retrospectively analyzed records of diabetic patients with and without ICMH who underwent nonemergent coronary angiography at our center. Primary study endpoint was 30-day major adverse cardiac events (MACE) and secondary endpoints were pre-and postprocedure fasting blood glucose (FBG), highest in hospital blood glucose, pre-and postprocedure systolic blood pressure (SBP), and use of intravenous insulin and antihypertensive medications. Results: A total of 88 diabetics with ICMH (study group) and 76 diabetics without ICMH (control group) undergoing angiography were enrolled. Demographics and hemoglobin A1c values were similar in both groups. Preprocedural FBG was significantly higher in the study group. The study group had significantly higher post angiography FBG (239.93 + 96.88 mg/dl vs. 156.6 + 59.88 mg/dl) and greater use of intravenous (IV) insulin (67.27% vs. 32.43%). Further, those who received steroids had significantly higher systolic SBP postprocedure (146.16 + 25.35 mmHg vs. 130.8 + 21.59 mmHg), a higher incidence of severe hypertension and use of IV antihypertensive medications (80.95% vs. 19.05%) periprocedurally. There were no differences in 30-day MACE between groups. Conclusion: Short-term steroid use for ICMH results in a significant increase in surrogate markers for adverse clinical events after coronary procedures. Study findings highlight the need for better periprocedural management of these patients and to limit steroid prophylaxis to those with only true ICMH.

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Acute hyperglycemia and contrast-induced nephropathy in primary percutaneous coronary intervention

Cited by 93 publications

References 32 publications

Pre-Procedural Glucose Levels and the Risk for Contrast-Induced Acute Kidney Injury in Patients Undergoing Emergency Coronary Intervention

Pre-Procedural Glucose Levels and the Risk for Contrast-Induced Acute Kidney Injury in Patients Undergoing Emergency Coronary Intervention

Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia

Impact of short term oral steroid use for intravenous contrast media hypersensitivity prophylaxis in diabetic patients undergoing nonemergent coronary angiography or interventions

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