The ratio of contrast volume to glomerular filtration rate predicts outcomes after percutaneous coronary intervention for ST‐segment elevation acute myocardial infarction

Mager, Aviv; Assa, Hana Vaknin; Lev, Eli I.; Bental, Tamir; Assali, Abid; Kornowski, Ran

doi:10.1002/ccd.22828

Cited by 61 publications

(43 citation statements)

References 14 publications

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“…Contrast-induced AKI is a prevalent and deleterious complication of coronary angiography and reported to be the third most common cause of hospital-acquired renal failure [7][8][9] . The contrast volume/eGFR ratio, recently shown to be a better predictor of AKI among patients undergoing PCI [18,19] , was not found to differ significantly between patients with and without AKI development in our cohort. This finding points to the possible impact of other factors besides contrast volume and reduced renal perfusion on the development of AKI in the setting of STEMI.…”

Section: Discussionmentioning

confidence: 67%

Prognostic Implications of Acute Renal Impairment among ST Elevation Myocardial Infarction Patients with Preserved Left Ventricular Function

et al. 2016

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Background: Only limited data is present regarding the incidence and prognostic implications of acute kidney injury (AKI) in ST elevation myocardial infarction (STEMI) patients with preserved left ventricular (LV) function in the primary percutaneous coronary intervention (PCI) era. Methods: We conducted a retrospective study of 842 consecutive STEMI patients with preserved LV function (ejection fraction ≥ 50%, assessed by echocardiography) who underwent primary PCI between January 2008 and January 2015. AKI was defined as an increase of ≥ 0.3 mg/dl in serum creatinine within 48 h following admission. Patients were assessed for all-cause mortality up to 5 years. Results: Fifty-two patients (6.2%) developed AKI. Patients with AKI were older, had impaired baseline renal function, and presented more often with heart failure throughout their hospitalization. Patients with AKI had a higher 5-year all-cause mortality (13.4 vs. 2.4%, p < 0.001). Compared to patients with no AKI, the adjusted hazard ratio for all-cause mortality was 2.64 (95% CI 1.25-5.56, p = 0.01). Conclusions: Among STEMI patients with preserved LV function undergoing primary PCI, AKI is associated with a higher long-term mortality.

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Section: Discussionmentioning

confidence: 67%

Prognostic Implications of Acute Renal Impairment among ST Elevation Myocardial Infarction Patients with Preserved Left Ventricular Function

et al. 2016

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“…This ratio has during recent years been studied with the goal of defining a threshold value for the risk of CIN in PCI [13][14][15][23][24][25][26][27]. Analysis of these studies demonstrates a weighted mean g-I/eGFR value >1.2 to be a significant and independent predictor of CIN (Table 2).…”

Section: Contrast Medium Dose/gfr Ratio As a Predictor Of Cinmentioning

confidence: 99%

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

et al. 2012

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We oppose the opinion that the intra-arterial administration of iodine-based contrast media (CM) appears to pose a greater risk of contrast medium-induced nephropathy (CIN) than intravenous administration since 1) in intra-arterial coronary procedures and most other intra-arterial angiographic examinations, CM injections are also intravenous relative to the kidneys, 2) there is a lack of comparative trials studying the risk of CIN between intra-arterial and intravenous procedures with matched risk factors and CM doses, 3) a bias selection of patients with fewer risk factors may explain the seemingly lower rate of CIN after CT in comparison with coronary interventions, 4) the rate of CIN following intra-arterial coronary procedures may also be exaggerated owing to other causes of acute kidney failure, such as haemodynamic instability and microembolisation, 5) roughly the same gramiodine/GFR ratio (≈1:1) as a limit of relatively safe CM doses has preliminarily been found for both intravenous CT and intra-arterial coronary procedures and 6) the substantially higher injected intravenous CM dose rate during CT relative to an intra-arterial coronary procedure might actually pose a higher risk of CIN following CT. Key Points• Most intra-arterial injections of contrast media are intravenous relative to the kidneys.• No evidence that intravenous CM injections should be less nephrotoxic than intra-arterial.• Considerably higher dose rates of CM are used for CT relative to intra-arterial procedures. • Higher dose rates may pose higher nephrotoxic risk for intravenous based CT studies.

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“…However, the impact of V/GFR on short-and long-term prognosis after primary PCI has not been evaluated so far. Therefore, we aimed to investigate the impact of V/GFR for predicting adverse cardiac events after primary PCI for ST-segment elevation acute myocardial infarction (STEMI) [14].…”

Section: Introductionmentioning

confidence: 99%

“…The ratio of 3.7 for V/GFR was found the cut-off value for predicting this increase [13]. Mager et al [14] studied the association between V/GFR, post-procedural CIN and 1-month mortality in patients with STEMI. In line with Laskey et al [13], the ratio of > 3.7 was found to be associated with CIN and 1-month mortality.…”

mentioning

confidence: 99%

The ratio of contrast volume to glomerular filtration rate predicts in-hospital and six-month mortality in patients undergoing primary angioplasty for ST-elevation myocardial infarction

et al. 2015

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The ratio of contrast volume to glomerular filtration rate predicts outcomes after percutaneous coronary intervention for ST‐segment elevation acute myocardial infarction

Abstract: The contrast medium-to-GFR ratio is a strong predictor of CIN and of 1-month mortality in patients undergoing primary PCI for STEMI.

Cited by 61 publications

References 14 publications

Prognostic Implications of Acute Renal Impairment among ST Elevation Myocardial Infarction Patients with Preserved Left Ventricular Function

Prognostic Implications of Acute Renal Impairment among ST Elevation Myocardial Infarction Patients with Preserved Left Ventricular Function

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

The ratio of contrast volume to glomerular filtration rate predicts in-hospital and six-month mortality in patients undergoing primary angioplasty for ST-elevation myocardial infarction

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