Association of chronic kidney disease with periprocedural myocardial injury after elective stent implantation

Abstract

Coronary artery disease (CAD) is the leading cause of mortality in patients with chronic kidney disease (CKD). Patients with CKD who undergo percutaneous coronary intervention (PCI) may have more ischemic events than patients without CKD. The aim of our study was to determine the incidence of periprocedural myocardial injury (PMI) after elective stent implantation in patients with CKD using the Third Joint ESC/ACCF/AHA/WHF PMI definition.In a single center prospective cohort study, we enrolled 344 consecutive patients who underwent elective PCI in a period of 39 months. Serum troponin I (cTnI) concentrations were measured at baseline and at 8 and 16 hours after PCI. Periprocedural increase of cTnI, according to the most recent PMI definition, was used to define both the presence and intensity of PMI. Patients were further stratified according to the estimated glomerular filtration rate (eGFR) using 4 variable Modification of Diet in Renal Disease (MDRD) equation: control group with eGFR >90 mL/min/1.73 m2 and the CKD group with eGFR < 90 mL/min/1.73 m2, with further subdivision according to the CKD stage.We found no significant difference in the incidence as well as intensity of the PMI in the control (>90 mL/min/1.73 m2) and the CKD group (<90 mL/min/1.73 m2) both 8 and 16 hours after PCI. When the CKD patients were further subdivided according to their CKD stage, there was again no difference in the intensity or incidence of PMI compared to the control group. Further analyses of our data showed angina pectoris CCS IV, bare metal stent (BMS) implantation, and treatment with angiotensin-converting enzyme inhibitors (ACEI) as independent predictors of PMI. Furthermore, the presence of hypertension was inversely related to the occurrence of PMI.Applying the new guidelines for PMI and using the eGFR equation most suitable for our patients, we found no association between PMI and CKD. Further analyses showed other factors that could potentially influence the occurrence of PMI.

Effects of remote ischemic preconditioning on contrast induced nephropathy after percutaneous coronary intervention in patients with acute coronary syndrome

“…[ 2 , 3 ] The diagnostic criteria of CIN was that the absolute value of serum creatinine (Scr) in 48 to 72 hours after the injection of contrast agent was increased by >44.2 mmol/L or above the base value of 25%, and was not associated with other renal damage. [ 4 , 5 ] In addition to hydration, there is still no effective prophylactic regimen available to prevent occurrence of CIN recently. [ 6 ] Therefore, it is urgent to explore new methods to reduce the incidence of CIN.…”

Myocardial damage associated with elective percutaneous coronary intervention in Chinese patients: a retrospective study

“…14 By contrast, another study, in patients with chronic kidney disease who received elective PCI, found that hypertension was inversely related to the occurrence of PCI related myocardial injury. 25 Our findings suggest that continuous blood pressure monitoring may be beneficial peri-procedurally. The regression analysis also showed that a requirement for PCI in multiple coronary segments was more likely to be associated with PCI related myocardial damage.…”

“…[22][23][24] However, there is conflicting evidence about the relationship between hypertension and PCI related myocardial damage. 14,25 For example, one study using pooled data from 11 studies found that hypertension was an independent indicator of periprocedural MI. 14 By contrast, another study, in patients with chronic kidney disease who received elective PCI, found that hypertension was inversely related to the occurrence of PCI related myocardial injury.…”

Periprocedural myocardial and renal injury in patients undergoing elective percutaneous coronary interventions – is there an association?

“…The studies have yielded conflicting results. [22,23] However, we found no studies addressing the issue of concomitant renal and myocardial periprocedural injury. We tested different thresholds for PMI detection.…”