Changes in renal function and occurrence of contrast-induced nephropathy after percutaneous coronary interventions in patients with atrial fibrillation treated with non-Vitamin K oral anticoagulants or warfarin

Rocco A. Montone1, Giampaolo Niccoli1, Vincenzo Tufaro, Silvia Minelli, Michele Russo, Federico Vergni, Luigi Sommariva, Francesco Pelliccia, Francesco Bedogni, Filippo Crea

Research output: Contribution to journalArticle

Abstract

Introduction: Patients with atrial fibrillation (AF) receiving non-vitamin K oral anticoagulants (NOAC) have a slower decline in renal function than those taking warfarin. Moreover, a warfarin-related nephropathy has been described. Aim: We assessed variation of estimated glomerular filtration rate (eGFR) and occurrence of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with AF taking warfarin compared with NOAC. Material and methods: We retrospectively enrolled consecutive patients taking oral anticoagulation for AF undergoing PCI. The primary endpoint was variation in eGFR and serum creatinine levels within 48–72 h after PCI. The secondary endpoint was occurrence of CIN, defined as a ≥ 25% relative increase, or a ≥ 0.5 mg/dl absolute increase, in serum creatinine levels within 48–72 h. Results: We enrolled 420 patients (mean age: 75.0 ±5.5 years, 272 (64.7%) male), 124 (29.5%) treated with NOAC and 296 (70.5%) with warfarin. NOAC patients showed a reduced decline in renal function (eGFR change: –2.8 ±7.9 ml/min/1.73 m2 vs. –4.5 ±6.5 ml/min/1.73 m2, respectively, p = 0.02) and a smaller increase in serum creatinine levels (0.026 ±0.112 vs. 0.055 ±0.132, p = 0.032) after PCI compared with warfarin. In the multivariate linear regression model independent predictors of eGFR changes were diabetes, baseline eGFR ≤ 60 ml/min/1.73 m2 and warfarin use. Occurrence of CIN did not differ between NOAC and warfarin patients (13 (10.5%) vs. 46 (15.5%), p = 0.22). Conclusions: Patients with AF taking NOAC have a reduced decline in renal function after PCI compared with warfarin. The NOAC may be a reasonable option for patients with a high risk of developing CIN.

Original languageEnglish
Pages (from-to)59-67
Number of pages9
JournalPostepy w Kardiologii Interwencyjnej
Volume15
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

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Keywords

  • Atrial fibrillation
  • Contrast-induced nephropathy
  • Non-Vitamin K oral anticoagulants
  • Percutaneous coronary intervention
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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