Pre-Procedural Risk Score of Contrast-Induced Nephropathy in Elderly Patients Undergoing Elective Coronary Angiography

Lian, Dan; Liu, Yong; Liu, Yuanhui; Li, Hualong; Duan, Chongyang; Yu, Danqing

doi:10.1536/ihj.16-129

Cited by 18 publications

(25 citation statements)

References 23 publications

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“…14,15,21) Our results verified this approach by showing that the attenuation of images at 40-60 keV monoenergetic spectral levels are at least comparable or even higher than with the use of 100 kVp, which has been illustrated in Figure 1. Since chronic renal insufficiency and kidney disease are very common among patients with CAD, 22,23) this significant reduction in iodine load could enormously benefit patients with borderline renal function and increased risk of contrast-induced nephropathy, 24) which has been increasingly discussed and widely recognized. 14,15,25) Multiple studies have demonstrated DECT's expanded role in providing a more comprehensive cardiac assessment.…”

Section: Discussionmentioning

confidence: 99%

Low Dose and Low Contrast Medium Coronary CT Angiography Using Dual-Layer Spectral Detector CT

Zhao

et al. 2019

Int. Heart J.

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The aim of the present study was to investigate the performance of low keV mono-energetic reconstructions in spectral coronary computed tomography angiography (CCTA) using spectral detector CT (SDCT) with reduced contrast media and radiation dose. Sixty patients were randomly assigned to Groups A and B (both n = 30) to undergo CCTA on a dual-layer SDCT with tube voltage 120 kVp and 100 kVp (average tube current: 108.5 and 73.8 mAs, respectively), with contrast media volume of 36 mL used in both groups. The mono-energetic 40-80 keV and conventional 120 kVp images in Group A and conventional 100 kVp images in Group B were reconstructed. Quantitative and qualitative image quality (IQ) were evaluated in the aortic root and distal segments of the coronary arteries. The patient characteristics were not significantly different between the two groups (all P !0.47), nor was the effective radiation dose (1.5 ± 0.3 and 1.4 ± 0.3 mSv, P = 0.20). The quantitative IQ in aorta and coronary arteries of mono-energetic 40-60 keV was superior to conventional 120 kVp and 100 kVp images (all P < 0.05). The noise in spectral images was lower compared to conventional images (all P < 0.01). The subjective IQ score of 40-50 keV images was not significantly different from that of 100 kVp images (P > 0.8). The mono-energetic 40-50 keV reconstructions from spectral CCTA using SDCT provide improved IQ compared to conventional techniques while facilitating reduced radiation dose and contrast media.

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Section: Discussionmentioning

confidence: 99%

Low Dose and Low Contrast Medium Coronary CT Angiography Using Dual-Layer Spectral Detector CT

Zhao

et al. 2019

Int. Heart J.

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“…4) Various methods for preventing CIN have been reported, including hydration, hemofiltration, intravenous administration of iloprost, and the use of ascorbic acid, nicorandil, or N-acetylcysteine. [5][6][7][8][9][10][11][12][13][14] However, there is presently no gold standard method and CIN occurs in approximately 5%-18.5% of patients, even when preventive methods are applied. The most effective method to prevent CIN is contrast volume reduction 15) .…”

Section: Discussionmentioning

confidence: 99%

“…However, despite the dangers, many previous studies have used over 100 mL of iodinated contrast medium, except when performing carbon dioxide angioplasty. [5][6][7][8][9][10][11][12][13][14] EVT can be performed effectively with carbon dioxide angioplasty in CKD patients. 16,17) However, this method is associated with severe complications and poor image quality.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Therapy Using Diluted Contrast Medium for Critical Limb Ischemia in a Patient with Chronic Kidney Disease

et al. 2019

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A high percentage of patients with critical limb ischemia have concurrent chronic kidney disease (CKD). However, endovascular therapy (EVT) can be problematic in CKD patients. Thus, we developed a method of EVT using digital subtraction angiography (DSA) with diluted contrast medium (low-concentration DSA), wherein DSA parameters were adjusted for diluted contrast angiography (1:10 dilution). Herein, we report the case of an 88-year-old woman with a foot wound and severe CKD. Her estimated glomerular filtration rate was 7.9 mL/minute/1.73 m 2. Therefore, EVT was performed with low-concentration DSA. Control angiography revealed total occlusion of the anterotibial and posterotibial arteries as well as severe stenosis of the peroneal artery. EVT with ballooning of the below-the-knee (BTK) lesions resulted in sufficient flow to the wound. Angiographic images of sufficient quality and visible wound blush were obtained with 1:10 diluted contrast medium. Because only 20 mL of contrast medium was required, renal function was preserved. EVT using DSA with diluted contrast medium was shown to be an effective BTK intervention in this CKD patient.

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“…In addition, we excluded 11 post-procedure risk scores for CI-AKI according to our goals [18][19][20][21][22][23][24][25][26][27][28], and due to lack of C-reactive protein data, the Athens score was excluded [29]. We ultimately included 8 preoperative risk scores for CI-AKI in the final validation analysis [30][31][32][33][34][35][36][37].…”

Section: Overview Of Risk Scoresmentioning

confidence: 99%

Validation of pre-operative risk scores of contrast-induced acute kidney injury in a Chinese cohort

Zhang

Zhou

et al. 2020

BMC Nephrol

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Background: Pre-operative risk scores are more valuable than post-procedure risk scores because of lacking effective treatment for contrast-induced acute kidney injury (CI-AKI). A number of pre-operative risk scores have been developed, but due to lack of effective external validation, most of them are also difficult to apply accurately in clinical practice. It is necessary to review and validate the published pre-operative risk scores for CI-AKI. Materials and methods: We systematically searched PubMed and EMBASE databases for studies of CI-AKI preoperative risk scores and assessed their calibration and discriminatory in a cohort of 2669 patients undergoing coronary angiography or percutaneous coronary intervention (PCI) from September 2007 to July 2017. The definitions of CI-AKI may affect the validation results, so three definition were included in this study, CI-AKI broad1 was defined as an increase in serum creatinine (Scr) of 44.2 μmol/L or 25%; CI-AKI broad2, an increase in Scr of 44.2 μmol/L or 50%; and CI-AKI-narrow, an increase in Scr of 44.2 μmol/L. The calibration of the model was assessed with the Hosmer-Lemeshow test and the discriminatory capacity was identified by C-statistic. Results: Of the 8 pre-operative risk scores for CI-AKI identified, 7 were single-center study and only 1 was based on multi-center study. In addition, 7 of the scores were just validated internally and only Chen score was externally validated. In the validation cohort of 2669 patients, the incidence of CI-AKI ranged from 3.0%(Liu) to 16.4%(Chen) for these scores. Furthermore, the incidence of CI-AKI was 6.59% (178) for CI-AKI broad1, 1.44% (39) for CI-AKI broad2, and 0.67% (18) for CI-AKI-narrow. For CI-AKI broads, C-statistics varied from 0.44 to 0.57. For CI-AKI-narrow, the Maioli score had the best discrimination and calibration, what's more, the C-statistics of Maioli, Chen, Liu and Ghani was ≥0.7. Conclusion: Most pre-operative risk scores were established based on single-center studies and most of them lacked external validation. For CI-AKI broads, the prediction accuracy of all risk scores was low. The Maioli score had the best discrimination and calibration, when using the CI-AKI-narrow definition.

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Pre-Procedural Risk Score of Contrast-Induced Nephropathy in Elderly Patients Undergoing Elective Coronary Angiography

Cited by 18 publications

References 23 publications

Low Dose and Low Contrast Medium Coronary CT Angiography Using Dual-Layer Spectral Detector CT

Low Dose and Low Contrast Medium Coronary CT Angiography Using Dual-Layer Spectral Detector CT

Endovascular Therapy Using Diluted Contrast Medium for Critical Limb Ischemia in a Patient with Chronic Kidney Disease

Validation of pre-operative risk scores of contrast-induced acute kidney injury in a Chinese cohort

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