Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality

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Abstract

Background: Contrast-induced nephropathy (CIN) frequently occurs in patients with acute ST-segment elevation myocardial infarction (STEMI) who are undergoing primary percutaneous coronary intervention, and CIN is associated with a more complicated clinical course and increased mortality. Objective: To investigate the association between absolute and weight-and creatinine-adjusted contrast volume, CIN incidence, and clinical outcome in the era of mechanical reperfusion of STEMI. Design: Prospective, observational study. Setting: A university cardiology center in Milan, Italy. Patients: 561 consecutive patients with STEMI who were undergoing primary percutaneous coronary intervention. Measurements: For each patient, the maximum contrast dose was calculated, according to the formula (5 × body weight [kg])/serum creatinine, and the contrast ratio, defined as the ratio between the contrast volume administered and the maximum dose calculated, was assessed. An increase in serum creatinine of more than 25% from baseline was defined as CIN. Results: 115 (20.5%) patients developed CIN. In-hospital mortality was higher among patients with CIN than those without CIN (21.4% vs. 0.9%; P<0.001). The maximum contrast dose was exceeded in 130 (23%) patients. Patients who received more than the maximum contrast dose (contrast ratio >1) had a more complicated in-hospital clinical course and higher mortality rate (13% vs. 2.8%; P<0.001) than did patients with a contrast ratio less than 1. Development of CIN was associated with both contrast volume and contrast ratio. Limitation: The association between contrast volume and outcomes was observed in a single center and could be due to co-morbid conditions, disease severity, or an unknown factor. Conclusion: During primary percutaneous coronary intervention for STEMI, higher contrast volume is associated with higher rates of CIN and mortality; however, further study is needed to determine whether limiting contrast volume would improve patient outcome. Funding: Centro Cardiologico Monzino, Institute of Cardiology, University of Milan.

Original languageEnglish
Pages (from-to)170-177
Number of pages8
JournalAnnals of Internal Medicine
Volume150
Issue number3
Publication statusPublished - Feb 3 2009

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Percutaneous Coronary Intervention
Mortality
Creatinine
Myocardial Infarction
Cardiology
Hospital Mortality
Serum
Italy
Reperfusion
Observational Studies
Body Weight
Prospective Studies
Weights and Measures
Incidence

ASJC Scopus subject areas

  • Internal Medicine

Cite this

@article{a24b1fe7c9094b4bbba6d042db782e78,
title = "Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality",
abstract = "Background: Contrast-induced nephropathy (CIN) frequently occurs in patients with acute ST-segment elevation myocardial infarction (STEMI) who are undergoing primary percutaneous coronary intervention, and CIN is associated with a more complicated clinical course and increased mortality. Objective: To investigate the association between absolute and weight-and creatinine-adjusted contrast volume, CIN incidence, and clinical outcome in the era of mechanical reperfusion of STEMI. Design: Prospective, observational study. Setting: A university cardiology center in Milan, Italy. Patients: 561 consecutive patients with STEMI who were undergoing primary percutaneous coronary intervention. Measurements: For each patient, the maximum contrast dose was calculated, according to the formula (5 × body weight [kg])/serum creatinine, and the contrast ratio, defined as the ratio between the contrast volume administered and the maximum dose calculated, was assessed. An increase in serum creatinine of more than 25{\%} from baseline was defined as CIN. Results: 115 (20.5{\%}) patients developed CIN. In-hospital mortality was higher among patients with CIN than those without CIN (21.4{\%} vs. 0.9{\%}; P<0.001). The maximum contrast dose was exceeded in 130 (23{\%}) patients. Patients who received more than the maximum contrast dose (contrast ratio >1) had a more complicated in-hospital clinical course and higher mortality rate (13{\%} vs. 2.8{\%}; P<0.001) than did patients with a contrast ratio less than 1. Development of CIN was associated with both contrast volume and contrast ratio. Limitation: The association between contrast volume and outcomes was observed in a single center and could be due to co-morbid conditions, disease severity, or an unknown factor. Conclusion: During primary percutaneous coronary intervention for STEMI, higher contrast volume is associated with higher rates of CIN and mortality; however, further study is needed to determine whether limiting contrast volume would improve patient outcome. Funding: Centro Cardiologico Monzino, Institute of Cardiology, University of Milan.",
author = "Giancarlo Marenzi and Emilio Assanelli and Jeness Campodonico and Gianfranco Lauri and Ivana Marana and {De Metrio}, Monica and Marco Moltrasio and Marco Grazi and Mara Rubino and Fabrizio Veglia and Franco Fabbiocchi and Bartorelli, {Antonio L.}",
year = "2009",
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language = "English",
volume = "150",
pages = "170--177",
journal = "Annals of Internal Medicine",
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TY - JOUR

T1 - Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality

AU - Marenzi, Giancarlo

AU - Assanelli, Emilio

AU - Campodonico, Jeness

AU - Lauri, Gianfranco

AU - Marana, Ivana

AU - De Metrio, Monica

AU - Moltrasio, Marco

AU - Grazi, Marco

AU - Rubino, Mara

AU - Veglia, Fabrizio

AU - Fabbiocchi, Franco

AU - Bartorelli, Antonio L.

PY - 2009/2/3

Y1 - 2009/2/3

N2 - Background: Contrast-induced nephropathy (CIN) frequently occurs in patients with acute ST-segment elevation myocardial infarction (STEMI) who are undergoing primary percutaneous coronary intervention, and CIN is associated with a more complicated clinical course and increased mortality. Objective: To investigate the association between absolute and weight-and creatinine-adjusted contrast volume, CIN incidence, and clinical outcome in the era of mechanical reperfusion of STEMI. Design: Prospective, observational study. Setting: A university cardiology center in Milan, Italy. Patients: 561 consecutive patients with STEMI who were undergoing primary percutaneous coronary intervention. Measurements: For each patient, the maximum contrast dose was calculated, according to the formula (5 × body weight [kg])/serum creatinine, and the contrast ratio, defined as the ratio between the contrast volume administered and the maximum dose calculated, was assessed. An increase in serum creatinine of more than 25% from baseline was defined as CIN. Results: 115 (20.5%) patients developed CIN. In-hospital mortality was higher among patients with CIN than those without CIN (21.4% vs. 0.9%; P<0.001). The maximum contrast dose was exceeded in 130 (23%) patients. Patients who received more than the maximum contrast dose (contrast ratio >1) had a more complicated in-hospital clinical course and higher mortality rate (13% vs. 2.8%; P<0.001) than did patients with a contrast ratio less than 1. Development of CIN was associated with both contrast volume and contrast ratio. Limitation: The association between contrast volume and outcomes was observed in a single center and could be due to co-morbid conditions, disease severity, or an unknown factor. Conclusion: During primary percutaneous coronary intervention for STEMI, higher contrast volume is associated with higher rates of CIN and mortality; however, further study is needed to determine whether limiting contrast volume would improve patient outcome. Funding: Centro Cardiologico Monzino, Institute of Cardiology, University of Milan.

AB - Background: Contrast-induced nephropathy (CIN) frequently occurs in patients with acute ST-segment elevation myocardial infarction (STEMI) who are undergoing primary percutaneous coronary intervention, and CIN is associated with a more complicated clinical course and increased mortality. Objective: To investigate the association between absolute and weight-and creatinine-adjusted contrast volume, CIN incidence, and clinical outcome in the era of mechanical reperfusion of STEMI. Design: Prospective, observational study. Setting: A university cardiology center in Milan, Italy. Patients: 561 consecutive patients with STEMI who were undergoing primary percutaneous coronary intervention. Measurements: For each patient, the maximum contrast dose was calculated, according to the formula (5 × body weight [kg])/serum creatinine, and the contrast ratio, defined as the ratio between the contrast volume administered and the maximum dose calculated, was assessed. An increase in serum creatinine of more than 25% from baseline was defined as CIN. Results: 115 (20.5%) patients developed CIN. In-hospital mortality was higher among patients with CIN than those without CIN (21.4% vs. 0.9%; P<0.001). The maximum contrast dose was exceeded in 130 (23%) patients. Patients who received more than the maximum contrast dose (contrast ratio >1) had a more complicated in-hospital clinical course and higher mortality rate (13% vs. 2.8%; P<0.001) than did patients with a contrast ratio less than 1. Development of CIN was associated with both contrast volume and contrast ratio. Limitation: The association between contrast volume and outcomes was observed in a single center and could be due to co-morbid conditions, disease severity, or an unknown factor. Conclusion: During primary percutaneous coronary intervention for STEMI, higher contrast volume is associated with higher rates of CIN and mortality; however, further study is needed to determine whether limiting contrast volume would improve patient outcome. Funding: Centro Cardiologico Monzino, Institute of Cardiology, University of Milan.

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M3 - Article

VL - 150

SP - 170

EP - 177

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

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