Impact of Blood Glucose Levels on Contrast Induced Nephropathy after Percutaneous Coronary Intervention in Patients not known to be Diabetic with Acute Coronary Syndrome.

Abstract

Background: Contrast-Induced Nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. The association between pre-procedural blood glucose levels and CI-AKI risk (regardless of pre-existing diabetes) is unknown. The present study was conducted to evaluate the incidence of CI-AKI in patients with admission hyperglycemia in non-diabetic ACS patients. Methods: This is Prospective, observational study done in the department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. Considering inclusion and exclusion criteria, 50 patients were non diabetic with ACS with normal blood glucose (d”7.8 mmol/l or d”140 mg/dl) in (Group I) and 50 patients were non diabetic with ACS with high blood glucose (>7.8 mmol/l or >140 mg/dl) undergoing percutaneous coronary intervention in (Group II). On admission random blood glucose was measured. Non- ionic low osmolar contrast agents (lopamidol) was used in all patients. Serum creatinine, serum electrolytes was measured and creatinine clearance rate was determined within 24 hours before PCI and day 1 and 2 after PCI. Results: The incidence of CIN was 24% in high blood glucose group and 4% in normal blood glucose group (p=0.004). It was also observed that gradual incremental increase in risk of CIN associated with higher admission blood glucose level. There was positive correlation between s. creatinine and admission blood glucose but it showed negative correlation between CCr and admission blood glucose after PCI in ACS patients not known to be diabetic. Conclusion: The present study reveals that index admission high blood glucose in acute coronary syndrome patients not known to be diabetic is associated with increased incidence of contrast induced nephropathy after percutaneous coronary intervention. Cardiovascular Journal Volume 6, No. 1, 2013, Page 23-30 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16111

ABO Blood Group and Severity of Coronary Artery Disease Assessed by Syntax Score in Patients with Acute Myocardial

“…Low SYNTAX score (d"22) was 16% and 56% in group I and II respectively indicates that patients of non-O blood group having less severe disease in comparison to O blood group patients. Similar results were observed in intermediate (23)(24)(25)(26)(27)(28)(29)(30)(31)(32) and high (>32) SYNTAX score in group-I and group-II respectively.…”

“…According to Akhand et al 22 most prevalent risk factors were smoking (60%) and dyslipidemia (60%) among the patients of CAD. Islam & Majumder (2013) reported high prevalence of hypertension (20% in adult and 40-65% in elderly) in Bangladeshi population that contributes to CAD 25 . However, a study in USA Mukherjee et al 2005, these findings are different, where 30.5% was diabetic, 66.8% hypertensive, 60.6% dyslipidemic, 21.3% smoker.…”

Association of random glucose to albumin ratio with post-contrast acute kidney injury and clinical outcomes in patients with ST-elevation myocardial infarction

“…Random glucose testing is an optimal option in this situation. In clinical trials, researchers discovered that high random blood glucose significantly increased the risk of PC-AKI after PCI in patients with acute coronary syndrome who did not have diabetes ( 8 ). Previous study including 13,3792 non-diabetes patients concluded that an increased random glucose value is a risk factor for diabetes ( 27 ) and could predict acceptable overall glycemic control in non-insulin-dependent diabetic patients ( 28 ).…”

“…Investigating some novel and potentially modifiable predictors may help to minimize PC-AKI incidence. Recent studies found non-diabetic patients with elevated pre-procedural random glucose have a higher risk of PC-AKI ( 7 , 8 ). Both fasting glucose and random glucose can predict in-hospital events in STEMI patients, but random glucose is more convenient in real-time and easier to obtain ( 9 ).…”

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“…Investigating some novel and potentially modifiable predictors may help to minimize PC-AKI incidence. Recent studies found non-diabetic patients with elevated pre-procedural random glucose have a higher risk of PC-AKI (7,8). Both fasting glucose and random glucose can predict inhospital events in STEMI patients, but random glucose is more convenient in real-time and easier to obtain (9).…”