Incidence, Predictors and Outcomes of Contrast Induced Nephropathy in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Khalfallah, Mohamed Tahar; Allaithy, Amany; Maria, Dina A.

doi:10.5334/gh.1071

Cited by 12 publications

(12 citation statements)

References 27 publications

(30 reference statements)

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“…So, stress hyperglycemia may aggravate the negative effects of contrast media exposure and increases the risk of contrast-induced nephropathy. Although contrast-induced nephropathy could be seen with the use of higher doses of contrast media [ 45 46 ], in the current study the volume of contrast agent showed no statistically significant difference between both groups. In agreement to our results Marenzi et al [ 47 ], who studied the effect of acute hyperglycemia and its relation to contrast-induced nephropathy in patients with STEMI after PPCI stated that, patients with acute hyperglycemia had a 2-fold higher incidence of contrast-induced nephropathy than those without acute hyperglycemia [ 34 ].…”

Section: Discussioncontrasting

confidence: 61%

Impact of Stress Hyperglycemia on No-Reflow Phenomenon in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

2022

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Background: Stress hyperglycemia is a common finding during acute myocardial infarction and associated with poor prognosis. To reduce the occurrence of no-reflow, prognostic factors must be identified before primary percutaneous coronary intervention (PPCI). Our objective was to investigate the impact of stress hyperglycemia in non-diabetic and diabetic patients on no-reflow phenomenon after PPCI. Methods: The study comprised 480 patients with ST elevation myocardial infarction (STEMI) who were managed by PPCI. Patients were classified into two groups according to thrombolysis in myocardial infarction (TIMI) flow grade: Group I (Patients with normal flow, TIMI 3 flow) and Group II (Patients with no-reflow, TIMI 0-2 flow). Patients were analyzed for clinical outcomes including mortality and major adverse cardiac events. Results: Incidence of stress hyperglycemia was 14.8% in non-diabetic patients and 22.2% in diabetic patients; the incidence of no-reflow phenomenon was 13.5% and no-reflow was significantly higher in patients with stress hyperglycemia. Multivariate regression analysis identified the independent predictors of no-reflow phenomenon: stress hyperglycemia OR 3.247 (CI95% 1.656–6.368, P = 0.001), Killip class >1 OR 1.893 (CI95% 1.004–3.570, P = 0.049) and cardiogenic shock OR 3.778 (CI95% 1.458–9.790, P = 0.006). Conclusion: Stress hyperglycemia was associated with higher incidence of no-reflow phenomenon. The independent predictors of no-reflow were stress hyperglycemia, Killip class >1 and cardiogenic shock.

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Section: Discussioncontrasting

confidence: 61%

Impact of Stress Hyperglycemia on No-Reflow Phenomenon in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

2022

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“…Previous studies reported that the incidence of AKI following primary PCI varied between 10%-30% defined as an increase in serum creatinine ≥ 25% or ≥ 44.2 mmol/L above baseline within 48-72 h after exposure to contrast medium. [10][11][12][13] Our study showed the incidence of AKI was about 27.0% of the whole STEMI patients, and AKI occurred as frequently with and without contrast media exposure within the first 72 h. Actually, the role of contrast media, which was the well-known predictor of AKI previously, has been questioned by Caspi, et al [14] among STEMI patients. In this study, they concluded that the rates of AKI, and risk for AKI were similar among STEMI patients regardless of exposure to contrast media.…”

Section: Discussionmentioning

confidence: 60%

Incidence, predictors and prognosis of acute kidney injury in acute ST-segment elevation myocardial infarction patients undergoing emergent coronary angiography/primary percutaneous coronary intervention

Tan

Zhang

Jin

et al. 2023

Journal of Geriatric Cardiology

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BACKGROUND Acute kidney injury (AKI) after coronary angiography (CAG) and primary percutaneous coronary intervention (PPCI) is frequently observed, and often interpreted as contrast induced-AKI. This study aimed to investigate the incidence, predictors and outcomes of AKI in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing emergent CAG/ PPCI using the control group of STEMI patients who were not exposed to contrast agents within the first 72 h. METHODSWe performed a retrospective analysis of 1670 STEMI patients. Of them, 673 patients underwent emergent CAG/PP-CI, and 997 patients treated with thrombolysis or no reperfusion therapy who were not exposed to contrast material during the first 72 h. AKI was defined as an increase of serum creatinine ≥ 44.2 mmol/L or ≥ 25% from baseline within 72 h. Patents were then followed up for the occurrence of all-cause mortality for 40 months (interquartile range: 24-55 months). RESULTSAfter propensity score matching, 505 pairs of patients were matched. Overall, the incidence of AKI was 27.4%, and AKI rates were not significantly different in patients with and without emergent CAG/PPCI procedure (27.5% vs. 27.3%, P = 0.944). Multivariate logistic regression analysis identified that the independent predictors of AKI were female, elevated interleukin-6 level, decreased lymphocyte count, left ventricular ejection fraction < 50% and use of diuretics in patients with emergent CAG/PPCI. Patients with AKI than those without AKI experienced higher incidence of acute heart failure with Killip class III (9.4% vs. 3.3%, P = 0.005; 15.2% vs. 6.8%, P = 0.003, respectively) and mortality (5.8% vs. 1.4%, P = 0.014; 12.3% vs. 4.6%, P = 0.002, respectively) in patients with and without emergent CAG/PPCI. Multivariate Cox regression analysis confirmed that AKI was independently associated with long-term mortality rate at 40 months follow-up in patients with and without emergent CAG/PPCI (HR = 1.867, 95% CI: 1.086-3.210, P = 0.024; HR = 1.700, 95% CI: 1.219-2.370, P = 0.002, respectively). CONCLUSIONS Approximately 27.0% of STEMI patients experience AKI, which is strongly associated with an increased shortand long-term mortality regardless of emergent CAG/PPCI procedure. The development of AKI is mainly related to female gender, inflammation reaction, heart failure and use of diuretics in STEMI patients undergoing emergent CAG/PPCI.

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“…[ 2 , 3 ] However, patients may develop contrast-induced nephropathy (CIN) after CAG or PCI, which is the third most common cause of hospital-acquired acute kidney injuries, [ 4 ] which prolongs hospital stay duration and significantly correlates with increased mortality, myocardial infarction, as well as stent thrombosis. [ 5 , 6 ] Since CIN does not have effective therapies, the early identification of patients at high risk of CIN occurrence is extremely important. A variety of risk factors for CIN have been identified, such as impaired renal function, diabetes mellitus, age, heart failure, and effective intravascular volume depletion.…”

Section: Introductionmentioning

confidence: 99%

Brain natriuretic peptide as a biomarker for predicting contrast-induced nephropathy in patients undergoing coronary angiography/intervention: A systematic review and meta-analysis

Yang

et al. 2022

Medicine

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Background: Contrast-induced nephropathy (CIN) is associated with adverse events. As there are no effective treatments, the early identification of high-risk patients is required. Individual studies have suggested the utility of brain natriuretic peptide in predicting CIN. Therefore, this meta-analysis aimed to systematically investigate the value of brain natriuretic peptide in predicting CIN in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). Methods: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials Library, and Web of Science from inception date to March 9, 2022. Studies that evaluated the predictive value of brain natriuretic peptide for CIN outcomes in patients after CAG or PCI were included. The quality of the included studies was assessed using the QUADAS-2 tool. Diagnostic accuracy estimates were calculated using a random-effects model. Subgroup and meta-regression analyses were performed to identify the potential sources of heterogeneity. Results: Twelve studies with 7789 patients were included in the meta-analysis. The pooled sensitivity and specificity of brain natriuretic peptide for the prediction of CIN were 0.73 (95% CI: 0.67–0.78) and 0.77 (95% CI: 0.71–0.82), respectively. The area under the summary receiver operating characteristic curve was 0.80 (95% CI: 0.77–0.84). Meta-regression analysis indicated that the sources of sensitivity heterogeneity may be the country, mean age, and study population. Additionally, country, study population, study design, and index text contributed to the specificity heterogeneity. Conclusion: This study demonstrated that brain natriuretic peptide could function as a novel potential marker for the early detection of CIN in patients undergoing CAG or PCI.

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Incidence, Predictors and Outcomes of Contrast Induced Nephropathy in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Cited by 12 publications

References 27 publications

Impact of Stress Hyperglycemia on No-Reflow Phenomenon in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Impact of Stress Hyperglycemia on No-Reflow Phenomenon in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Incidence, predictors and prognosis of acute kidney injury in acute ST-segment elevation myocardial infarction patients undergoing emergent coronary angiography/primary percutaneous coronary intervention

Brain natriuretic peptide as a biomarker for predicting contrast-induced nephropathy in patients undergoing coronary angiography/intervention: A systematic review and meta-analysis

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