Association of Preprocedural Hyperglycemia With Contrast-Induced Acute Kidney Injury and Poor Outcomes After Emergency Percutaneous Coronary Intervention

Abstract

We investigated whether preprocedural hyperglycemia was associated with contrast-induced acute kidney injury (CI-AKI) and long-term outcomes in patients with acute coronary syndrome (ACS) who underwent emergency percutaneous coronary intervention (PCI). Patients (n = 558) with ACS who underwent emergency PCI were consecutively enrolled. Preprocedural hyperglycemia was defined as glucose levels >198 mg/dL (11 mmol/L). The primary outcome was CI-AKI (≥0.3 mg/dL absolute or ≥50% relative serum creatinine increase 48 hours after contrast medium exposure). Overall, 103 (18.5%) patients had preprocedural hyperglycemia and 89 (15.9%) patients developed CI-AKI. The incidence of CI-AKI was significantly higher in patients with hyperglycemia than without (28.2% vs 13.2%; P < .01). Multivariate analysis indicated that preprocedural hyperglycemia was an independent predictor of CI-AKI (odds ratio = 1.971, 95% confidence interval [CI]: 1.129-3.441; P < .05). In addition, preprocedural hyperglycemia was associated with an increased risk of all-cause mortality during the 2-year follow-up (hazard ratio = 2.440, 95% CI: 1.394-4.273; P = .002). Preprocedural hyperglycemia is a significant and independent predictor of CI-AKI and long-term outcomes.

Predictors of acute kidney injury (AKI) in high-risk ST-elevation myocardial infarction (STEMI) patients: A single-center retrospective observational study

“…A quarter of all our STEMI patients and 40% of STEMI patients with AKI had a history of diabetes. Even in the absence of diabetes mellitus, acute hyperglycemia on admission was associated with increased in-hospital mortality in patients with acute myocardial infarction (AMI) [35]. Moreover, in those patients, admission acute hyperglycemia was an independent predictor of AKI [35] and, similarly, in patients with ACS preprocedural hyperglycemia was a predictor of contrast-induced AKI [35].…”

“…Even in the absence of diabetes mellitus, acute hyperglycemia on admission was associated with increased in-hospital mortality in patients with acute myocardial infarction (AMI) [35]. Moreover, in those patients, admission acute hyperglycemia was an independent predictor of AKI [35] and, similarly, in patients with ACS preprocedural hyperglycemia was a predictor of contrast-induced AKI [35]. Hyperglycemia has a negative effect on ischemic myocardium through mechanisms such as oxidative stress, inflammation, apoptosis, endothelial dysfunction, and platelet aggregation [36].…”

Predictive value of admission D-dimer for contrast-induced acute kidney injury and poor outcomes after primary percutaneous coronary intervention

“…Contrast-induced acute kidney injury (CI-AKI) is a common complication following coronary intervention procedures, which was associated with poor outcomes including dialysis, mortality, longer hospitalization and increased health-care costs [1][2][3], especially among patients undergoing primary percutaneous coronary intervention (pPCI) [4,5]. Therefore, it is important to identify the patients who are likely to develop CI-AKI and take early preventive measures in this population.…”

Predictive Value of Admission D-dimer for Contrast-induced Acute Kidney Injury and Poor Outcomes after Primary Percutaneous Coronary Intervention

“…Contrast-induced acute kidney injury (CI-AKI) is a common complication following coronary intervention procedures, which was associated with poor outcomes including dialysis, mortality, longer hospitalization and increased health-care costs [1][2][3], especially among patients undergoing primary percutaneous coronary intervention(pPCI) [4,5]. Therefore, it is important to identify the patients who are likely to develop CI-AKI and take early preventive measures in this population.…”