Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction

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Abstract

The aim of this research was to assess the incidence, clinical predictors, and outcome of contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Contrast-induced nephropathy is associated with significant morbidity and mortality after PCI. Patients undergoing primary PCI may be at higher risk of CIN because of hemodynamic instability and unfeasibility of adequate prophylaxis. In 208 consecutive AMI patients undergoing primary PCI, we measured serum creatinine concentration (Cr) at baseline and each day for the following three days. Contrast-induced nephropathy was defined as a rise in Cr >0.5 mg/dl. Overall, CIN occurred in 40 (19%) patients. Of the 160 patients with baseline Cr clearance ≥60 ml/min, only 21 (13%) developed CIN, whereas it occurred in 19 (40%) of those with Cr clearance 75 years (odds ratio [OR] 5.28, 95% confidence interval [CI] 1.98 to 14.05; p = 0.0009), anterior infarction (OR 2.17, 95% CI 0.88 to 5.34; p = 0.09), time-to-reperfusion >6 h (OR 2.51, 95% CI 1.01 to 6.16; p = 0.04), contrast agent volume >300 ml (OR 2.80, 95% CI 1.17 to 6.68; p = 0.02) and use of intraaortic balloon (OR 15.51, 95% CI 4.65 to 51.64; p <0.0001) were independent correlates of CIN. Patients developing CIN had longer hospital stay (13 ± 7 days vs. 8 ± 3 days; p <0.001), more complicated clinical course, and significantly higher mortality rate (31% vs. 0.6%; p <0.001). Contrast-induced nephropathy frequently complicates primary PCI, even in patients with normal renal function. It is associated with higher in-hospital complication rate and mortality. Thus, preventive strategies are needed, particularly in high-risk patients.

Original languageEnglish
Pages (from-to)1780-1785
Number of pages6
JournalJournal of the American College of Cardiology
Volume44
Issue number9
DOIs
Publication statusPublished - Nov 2 2004

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Angioplasty
Percutaneous Coronary Intervention
Myocardial Infarction
Odds Ratio
Confidence Intervals
Mortality
Infarction
Contrast Media
Reperfusion
Length of Stay
Creatinine
Hemodynamics
Morbidity
Kidney
Incidence
Serum
Research

ASJC Scopus subject areas

  • Nursing(all)

Cite this

@article{d92e61a98d384ad4bb66d31c73312c09,
title = "Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction",
abstract = "The aim of this research was to assess the incidence, clinical predictors, and outcome of contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Contrast-induced nephropathy is associated with significant morbidity and mortality after PCI. Patients undergoing primary PCI may be at higher risk of CIN because of hemodynamic instability and unfeasibility of adequate prophylaxis. In 208 consecutive AMI patients undergoing primary PCI, we measured serum creatinine concentration (Cr) at baseline and each day for the following three days. Contrast-induced nephropathy was defined as a rise in Cr >0.5 mg/dl. Overall, CIN occurred in 40 (19{\%}) patients. Of the 160 patients with baseline Cr clearance ≥60 ml/min, only 21 (13{\%}) developed CIN, whereas it occurred in 19 (40{\%}) of those with Cr clearance 75 years (odds ratio [OR] 5.28, 95{\%} confidence interval [CI] 1.98 to 14.05; p = 0.0009), anterior infarction (OR 2.17, 95{\%} CI 0.88 to 5.34; p = 0.09), time-to-reperfusion >6 h (OR 2.51, 95{\%} CI 1.01 to 6.16; p = 0.04), contrast agent volume >300 ml (OR 2.80, 95{\%} CI 1.17 to 6.68; p = 0.02) and use of intraaortic balloon (OR 15.51, 95{\%} CI 4.65 to 51.64; p <0.0001) were independent correlates of CIN. Patients developing CIN had longer hospital stay (13 ± 7 days vs. 8 ± 3 days; p <0.001), more complicated clinical course, and significantly higher mortality rate (31{\%} vs. 0.6{\%}; p <0.001). Contrast-induced nephropathy frequently complicates primary PCI, even in patients with normal renal function. It is associated with higher in-hospital complication rate and mortality. Thus, preventive strategies are needed, particularly in high-risk patients.",
author = "Giancarlo Marenzi and Gianfranco Lauri and Emilio Assanelli and Jeness Campodonico and {De Metrio}, Monica and Ivana Marana and Marco Grazi and Fabrizio Veglia and Bartorelli, {Antonio L.}",
year = "2004",
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language = "English",
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TY - JOUR

T1 - Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction

AU - Marenzi, Giancarlo

AU - Lauri, Gianfranco

AU - Assanelli, Emilio

AU - Campodonico, Jeness

AU - De Metrio, Monica

AU - Marana, Ivana

AU - Grazi, Marco

AU - Veglia, Fabrizio

AU - Bartorelli, Antonio L.

PY - 2004/11/2

Y1 - 2004/11/2

N2 - The aim of this research was to assess the incidence, clinical predictors, and outcome of contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Contrast-induced nephropathy is associated with significant morbidity and mortality after PCI. Patients undergoing primary PCI may be at higher risk of CIN because of hemodynamic instability and unfeasibility of adequate prophylaxis. In 208 consecutive AMI patients undergoing primary PCI, we measured serum creatinine concentration (Cr) at baseline and each day for the following three days. Contrast-induced nephropathy was defined as a rise in Cr >0.5 mg/dl. Overall, CIN occurred in 40 (19%) patients. Of the 160 patients with baseline Cr clearance ≥60 ml/min, only 21 (13%) developed CIN, whereas it occurred in 19 (40%) of those with Cr clearance 75 years (odds ratio [OR] 5.28, 95% confidence interval [CI] 1.98 to 14.05; p = 0.0009), anterior infarction (OR 2.17, 95% CI 0.88 to 5.34; p = 0.09), time-to-reperfusion >6 h (OR 2.51, 95% CI 1.01 to 6.16; p = 0.04), contrast agent volume >300 ml (OR 2.80, 95% CI 1.17 to 6.68; p = 0.02) and use of intraaortic balloon (OR 15.51, 95% CI 4.65 to 51.64; p <0.0001) were independent correlates of CIN. Patients developing CIN had longer hospital stay (13 ± 7 days vs. 8 ± 3 days; p <0.001), more complicated clinical course, and significantly higher mortality rate (31% vs. 0.6%; p <0.001). Contrast-induced nephropathy frequently complicates primary PCI, even in patients with normal renal function. It is associated with higher in-hospital complication rate and mortality. Thus, preventive strategies are needed, particularly in high-risk patients.

AB - The aim of this research was to assess the incidence, clinical predictors, and outcome of contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Contrast-induced nephropathy is associated with significant morbidity and mortality after PCI. Patients undergoing primary PCI may be at higher risk of CIN because of hemodynamic instability and unfeasibility of adequate prophylaxis. In 208 consecutive AMI patients undergoing primary PCI, we measured serum creatinine concentration (Cr) at baseline and each day for the following three days. Contrast-induced nephropathy was defined as a rise in Cr >0.5 mg/dl. Overall, CIN occurred in 40 (19%) patients. Of the 160 patients with baseline Cr clearance ≥60 ml/min, only 21 (13%) developed CIN, whereas it occurred in 19 (40%) of those with Cr clearance 75 years (odds ratio [OR] 5.28, 95% confidence interval [CI] 1.98 to 14.05; p = 0.0009), anterior infarction (OR 2.17, 95% CI 0.88 to 5.34; p = 0.09), time-to-reperfusion >6 h (OR 2.51, 95% CI 1.01 to 6.16; p = 0.04), contrast agent volume >300 ml (OR 2.80, 95% CI 1.17 to 6.68; p = 0.02) and use of intraaortic balloon (OR 15.51, 95% CI 4.65 to 51.64; p <0.0001) were independent correlates of CIN. Patients developing CIN had longer hospital stay (13 ± 7 days vs. 8 ± 3 days; p <0.001), more complicated clinical course, and significantly higher mortality rate (31% vs. 0.6%; p <0.001). Contrast-induced nephropathy frequently complicates primary PCI, even in patients with normal renal function. It is associated with higher in-hospital complication rate and mortality. Thus, preventive strategies are needed, particularly in high-risk patients.

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