Risk Factors Associated With Contrast-Induced Nephropathy after Primary Percutaneous Coronary Intervention

Abstract

Background Contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI) is associated with increased mortality and morbidity. The aim of this study is to determine the frequency of CIN after primary PCI and its association with risk factors in patients with STsegment elevation myocardial infarction (STEMI) at a tertiary care cardiac center in Pakistan. Methodology In this observational study, we included 282 patients who presented with STEMI and underwent primary PCI at the National Institute of Cardiovascular Disease, Karachi, Pakistan, from October 2017 to April 2018. The serum creatinine (mg/dL) levels were obtained at baseline and 48 to 72 hours after the primary PCI procedure, and patients with a 25% increase or ≥ 0.5 mg/dL rise in post-procedure creatinine level (after 48 to 72 hour) were categorized for CIN. Results Out of a total sample of 282 patients, 68.4% (193) were males, and the mean age was 56.4 ± 9.1 years. A majority of the patients, 78.7% (222), were hypertensive and 34% (96) were diabetic. The CIN was observed in 13.1% (37) of the patients, and increased risk of CIN was found to be associated with the presence of diabetes mellitus and increased (>200 mL) use of contrast during the procedure, with odds ratios of 2.3 (1.14-4.63) and 3.12 (1.36-7.17), respectively. Conclusions The CIN after PCI is a common complication associated with the presence of diabetes mellitus and the use of an increased amount of contrast during the procedure.

Contrast-Induced Nephropathy Factors and Prevalence in Patients Getting Multi-Vessel Percutaneous Coronary Intervention

“…These results were comparable to the previous studies. [21,22] Most common risk factor of CIP was contrast volume >150ml 19 (76%) and hypertension found in 17 (68%) cases, followed by diabetes mellitus in 15 (60%) cases, age >65 years in 13 (52%) cases, CHF in 11 (44%) cases, smoking history in 9 (36%) cases and family history of CAD was 4 (16%). Several previous research [23,24] have shown that there is a correlation between an increasing dose of contrast agent used during the surgery and a higher incidence of CIN.…”

Contrast volume and in-hospital outcomes of dialysis patients undergoing percutaneous coronary intervention

“…Patients were divided into two groups: those who received a contrast volume ≥ 200 ml and those who received a contrast volume < 200 ml. The cutoff was set as 200 ml because 100 ml increment of contrast volume is known to be associated with the risk of AKI, and 200 ml is more than the average volume administered at most PCI centers; furthermore, a previous study showed that ≥ 200 ml of contrast volume was the precipitating factor for AKI 2 , 4 , 17 . Angiographical stenosis was defined as > 50% stenosis for left anterior descending artery, left circumflex artery and right coronary artery and ≥ 50% stenosis for left main.…”

Frequency of Contrast-Induced Nephropathy in Patients Undergoing PCI

“…Higher intratubular pressure as a consequence of contrast-induced diuresis, in addition to heightened perivascular hydrostatic pressure, may lead to medullary hypoxia as a result of reduced medullary blood flow in some patients (4). If there is a loss of balance between vasoactive chemicals (such as endothelin and adenosine) and vasodilators (nitric oxide and prostaglandins), renal ischemia may occur (5). A significant amount of urine is required to flush the body of the high osmotic load of the contrast medium.…”