SHA 062. Incidence of contrast induced nephropathy in Saudi patient after cardiac catherization (original) (raw)
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Risk factors and incidence of contrast induced nephropathy following coronary intervention
Medical Journal of Indonesia, 2008
Contrast induced nephropathy (CIN) merupakan salah satu komplikasi pemberian media kontras yang paling penting. Akan tetapi, insidens dan faktor-faktor yang mempengaruhi CIN setelah suatu tindakan intervensi koroner belum pernah dilaporkan di Indonesia. CIN didefinisikan sebagai peningkatan kreatinin serum sebesar 0,5 mg/dl atau lebih pada hari ke 3 pasca tindakan. Dari 312 subyek yang ikut dalam penelitian ini didapatkan insidens CIN sebesar 25%. Pada analisis bivariat didapatkan faktor hipertensi, diabetes mellitus, kelas NYHA, volume dan jenis zat kontras, kadar kreatinin serum > 1,5 mg/dl, proteinuria dan fraksi ejeksi ≤ 35% secara bermakna mempengaruhi kejadian CIN. Pada analisis multivariate hanya hipertensi [hazard rasio (HR) = 2,89; 95% interval kepercayaan (CI) = 1,78 s/d 4,71; P = 0,000], diabetes mellitus (HR = 3,09; 95% CI = 1,89 s/d 5,06, P = 0,000), fraksi ejeksi (EF) ≤ 35% (HR = 2,92; 95% CI = 1,72 s/d 4,96; P = 0,000), volume zat kontrast > 300 ml (HR = 7.73; 95% CI 3,09 s/d 19,37; P = 0,000) dan proteinuria (HR = 14,96; 95% CI = 3,45 s/d 64,86; P = 0,000) yang merupakan faktos risiko bebas CIN. Kesimpulannya adalah insidens CIN pada hari ke 3 pada pasien yang dilakukan intervensi koroner sebesar 25%. Hipertensi, diabetes melitus, EF ≤ 35%, volume zat kontras > 300 ml dan proteinuria merupakan faktor risiko bebas CIN. (Med J Indones 2008;
The American Journal of Cardiology, 2009
Several definitions have been used to assess rates of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI). Whether the definition influences observed rates of CIN is unclear. The Oxilan Registry was the first-ever prospective analysis of the efficacy and safety of ioxilan (low-osmolar and low-viscosity contrast medium), including rates of CIN assessed by multiple definitions, in PCI. From July 2006 to June 2007, consecutive patients undergoing PCI using ioxilan were enrolled. Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) were assessed at baseline and 3 to 5 days after PCI. CIN was defined as SCr increase >0.5 mg/dl, eGFR decrease >25%, SCr increase >25%, or the composite. Of 400 patients (age 62 ؎ 11 years), 19% were women, 37% were diabetic, 22% were anemic, and 8% had a history of congestive heart failure. Baseline SCr was 1.12 ؎ 0.3 mg/dl and 24% had an eGFR <60 ml/min. CIN rates were 3.3% (SCr increase >0.5 mg/dl), 7.6% (eGFR decrease >25%), 10.2% (SCr increase >25%), and 10.5% (composite). Hospitalization was prolonged in 3.4% of patients with CIN and none required dialysis. There were no deaths or severe allergic reactions. Non-ST-elevation myocardial infarction and repeat revascularization each occurred in 0.8%. In conclusion, in this unselected population undergoing PCI, CIN ranged in frequency from 3.3% to 10.5% depending on the definition used and was not associated with in-hospital mortality or substantial morbidity, such as dialysis. The wide variation in CIN and its lack of association with adverse outcomes underscore the need for a standardized, clinically relevant definition.
Cureus, 2020
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 in 118 Coronary Angiographic Cases
Journal of Medicine, 2009
CIN is one of the common causes of acute renal insufficiency after cardiovascular procedures. Acute renal failure in connection with the administration of intravascular iodine-based contrast media (CM) was recognized long ago. CIN is defined as an impairment of renal functions subsequent to the administration of CM in the absence of any cause. CIN is diagnosed when there is an increase in serum creatinine concentration of e" 0.5 mg/dl or relative increase of e" 25% from the baseline within 72 hrs after CM administration. 1 The recovery occurs in majority of cases within 2-3 weeks.
Pan African Medical Journal, 2021
Introduction: contrast media are increasingly used in diagnostic and interventional procedures but are also known causes of acute kidney injury-a condition known as contrast induced nephropathy (CIN). We aimed to determine the magnitude and associated factors of CIN among patients undergoing coronary angiography and percutaneous coronary intervention at a cardiac referral hospital in Tanzania. Methods: all adult patients undergoing elective coronary angiography and percutaneous coronary intervention at Jakaya Kikwete Cardiac Institute were consecutively enrolled between August 2017 and January 2018, if they fulfilled the inclusion criteria. Pre-procedure, 24-and 72-hours' post procedure serum creatinine was measured. CIN was defined as increase of ≥25% or absolute increase of ≥44μmol/L of serum creatinine within 72 hours following exposure to contrast media. Data analysis were done using SPSS Version 20. P-value of <0.05 was considered statistically significant. Results: in total, 210 (94.6%) out of 222 patients seen during the study period fulfilled the inclusion criteria and were enrolled. Their mean (SD) age was 61.3 (10.9) years and 64.3% were men. Hypertension, diabetes, smoking and alcohol consumption was present in 86.7%, 37.7%, 12.4% and 37.6% respectively. The incidence of CIN was 19% within 72 hours post procedure. On multivariate logistic regression analysis, independent factors for developing CIN were history of heart failure (aOR=7.34), central obesity (aOR=3.12), triple vessel disease (aOR=10.14) and post procedure stay of ≥3 days (aOR=4.1), all p<0.05. Conclusion: the incidence of CIN found in this population is high (19%) and is associated with heart failure, obesity, multi-vessel disease and longer postprocedure hospital stay.
Contrast Induced Nephropathy in Patients with Acute Coronary Syndrome
BANTAO Journal, 2015
Introduction. Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality after percutaneous coronary intervention (PCI). On the other hand, CIN is a serious complication in patients with diabetes or renal impairment undergoing percutaneous coronary intervention (PCI). CIN after PCI may be associated with prolonged hospitalization, increased rates of kidney injury, and short-and long-term mortality. Factors that have been associated with CIN include: diabetes mellitus, congestive heart failure, recent acute myfocardial infarction, cardiogenic shock, and pre-existing renal impairment. In this study, we investigated contrast nephropathy development after coronary angiography (CAG) in patients presenting with acute coronary syndrome, who were hospitalized initially in the Coronary Care Unit and subsequenttly referred to the Internal Medicine Clinic in a tertiary care hospital. Methods. We've analyzed 335 patients' records retrospectively in 1 year that were followed-up with acute coronary syndrome (ACS) in the Coronary Care Unit (CCU) and transferred to the Internal Medicine Clinic (IMC). The following parameters were evaluated: age, gender, chronic disease and drug history, biochemical values evaluated before hospitalization to CCU, ejection fraction (EF) and left atrium diameter (LA), with or without previous CAG; values of serum creatinine (sCr) levels before CAG and after 48 hours. Values of p <0.05 were considered to be significant. Results. 126 of 335 patients were female and 209 were male. The average age of patients was 64.2 years. 122 patients used angiotensin converting enzyme inhibitor (ACEI), 54 patients used furosemide. CIN development rate of CAG patients was 22.8% (n=54). There was no significant relationship with age, gender and chronic disease history in CIN patients. When laboratory findings were compared, there was no significant relationship except for potassium value before CAG. However, potassium values were significantly higher in CIN patients (p=0.001). When drug usage of patients was compared, 48.1% (n=26) of CIN patients used ACEI and there was a significant relationship between ACEI use and CIN development (p=0.026). Conclusions. CIN development rate was 22.8% and it was relatively high when compared with literature data. Awareness about contrast nephropathy develepment risk and assessment of risk factors before the procedure should be increased in our Center.
International Journal of Cardiology, 2019
Background: Complex percutaneous coronary intervention (PCI) is associated with increased procedural challenges and high contrast load. We aimed to evaluate the association between complex PCI and contrastinduced nephropathy (CIN). Methods: This single-center retrospective study included all-comers undergoing PCI between January 2012 and December 2016. Complex PCI was defined as a procedure with ≥1 of the following characteristics: 3 vessels treated, ≥3 stents implanted, two-stent bifurcation intervention, total stent length N60 mm, PCI on a chronic total occlusion, saphenous vein graft, or left main, protected PCI, use of rotational/laser atherectomy. CIN was defined as an increase in post-PCI creatinine of ≥0.3 mg/dl or ≥50% from baseline. Results: We included 2660 patients (n = 1128 complex PCI, n = 1532 non-complex PCI). Complex PCI patients tended to be older, and had higher cardiovascular comorbidity and Mehran CIN risk score. They also had a higher prevalence of type B2/C lesions and need for mechanical circulatory support, and received a higher mean contrast volume (284 ± 137 vs. 189 ± 90 ml, p b 0.001). CIN incidence was similar in complex vs. non-complex PCI patients (12.1% vs. 11.5%, p = 0.63), as was the need for in-hospital dialysis (0.5% vs. 0.2%, p = 0.25). Upon multivariable adjustment, age, female sex, diabetes, ejection fraction, periprocedural hypotension, presentation with acute coronary syndrome, and contrast volume were independently associated with CIN, while complex PCI was not. Conclusions: Complex PCI is not associated with an increased risk of CIN in all-comers. Further studies should confirm our findings and investigate novel effective strategies to decrease the risk of this serious complication.
Journal of Cardiovascular Medicine, 2010
Objectives To develop a simplified scoring system based on preprocedure clinical characteristics to predict contrastinduced nephropathy (CIN) before elective coronary angiography and percutaneous coronary intervention (PCI). Background CIN is associated with increased mortality and morbidity following coronary angiography and PCI and accounts for increased hospital costs. Methods Several baseline clinical characteristics of 1218 patients were considered as candidate univariate predictors of CIN (increase >-0.5 mg/dl in serum creatinine within 5 days after contrast exposure). On the basis of the odds ratio at multivariate logistic regression, seven markers (with weighted scores) were identified as independent correlates of CIN: age at least 73 years (1), diabetes mellitus (2), left ventricular ejection fraction 45% or less (2), baseline serum creatinine value at least 1.5 mg/dl (2), baseline creatinine clearance 44 ml/min or less (2), posthydration creatinine >-prehydration creatinine value (2) and one procedure effected within the past 72 h (3). Results CIN occurred in 114 (9.4%) patients [range 1.1-52.1% for a low (<-3) and very high (>-9) risk score, respectively]; the odds of CIN increased significantly with each class (Cochran-Armitage chi-square, P < 0.0001) and the risk score allowed us to determine patients with low and high risk for postprocedure CIN (c-statistic U 0.86). These results were reproduced in a validation set. Conclusion Preprocedural clinical risk factors have different influences on the likelihood of CIN. Risk classification based on the most significant parameters can be used to predict CIN before contrast exposure. The simple scoring system proposed here provides a good estimate of the risk of CIN, allowing the interventional team to make adequate adjustment to the procedures. J Cardiovasc Med 11:444-449 Q 2010 Italian Federation of Cardiology.
Contrast-Induced Nephropathy After Cardiac Catheterization: Culprits, Consequences and Predictors
The American Journal of the Medical Sciences, 2017
Background: Contrast-induced nephropathy (CIN) is a common complication after radio-contrast exposure. Methods: A retrospective chart review of 513 hospitalized patients who underwent cardiac catheterization from June-December 2014 was done, of which 38 patients with end-stage renal disease and 57 patients without pre-procedural creatinine were excluded. Serum creatinine concentration before and each day for 3 days after the procedure were recorded. CIN was defined as an increase in serum creatinine concentration by ≥25% or ≥0.5mg/dl from the pre-procedural value within 72 hours of contrast exposure. Results: A total of 418 patients (mean age 69.1 ± 13.8, 55% male) were included in the study. Mean incidence of CIN was 3.7% (n=16). CIN accounted for longer duration of hospitalization, lengthier intensive care unit admission, requirement of hemodialysis and higher mortality. Incidence of CIN was higher in presence of preexisting Atrial fibrillation (AF), congestive heart failure (CHF) and chronic kidney disease (CKD). When tested by univariate analysis, incidence of CIN was 13.8% in AF group (p<0.001), 8.6% in CHF group (p<0.01) and 8.9% CKD group (p<0.002), compared to 2.3%, 1.9% and 2.4% in absence of pre existing AF, CHF and CKD. On further testing using multivariate logistic regression model using AF, CHF and CKD as independent variables, development of CIN was strongly associated with preexisting AF with an odds ratio (OR) 4.11, 95% confidence interval (CI) 1.40-12.07, p=0.01. Conclusion: Identifying patients at risk is an important step in preventing CIN. Preexisting AF, independent of traditional risk factors, may increase the risk for CIN.
The potential risk of thrombosis during coronary angiography using nonionic contrast media
Catheterization and Cardiovascular Diagnosis, 1989
The influence of contrast media on coagulation has an important association with thromboembolic complication during coronary anglography. in this study, whole blood was methodically mixed with nonionic contrast medium, lohexoi (IOH), conventional ionic contrast medium, Hypaque-76 (H76), and low osmolar ionic dimer Hexabrix (HB) in vitro. The thrombotic propensity of contrast agents can be evaluated by measuring the clot formation of the mixtures. The experiments were repeated with whole blood after systemic heparinization. In the in vitro study, 5 mi of canine (N = 10) and 3 mi of human (N = 11) whole blood was incubated for 30 min in glass tubes with equal volumes of IOH, H76, HB, and 0.9% NaCl before heparinlzation. Clot formation with IOH and 0.9% NaCi were seen both in dogs (4.0 f 0.7 gm and 5.6 f 0.8 gm) and in patients (1.4 f 0.9 gm and 2.9 f 1.3 gm), whereas no clot was seen with H76 or XB. Foilowing heparinization, no clot was visualized in any mixture of whole blood with contrast media or 0.9% NaCi. Similar results were observed in the catheter-syringe system with canine blood (N = 11) mixed with the contrast agents. Blood clots found in 15 min and 30 min of IOH were 0.07 * 0.08 gm and 0.44 f 0.20 gm (P c 0.01) and of NaCi were 0.29 f 0.37 gm and 0.69 f 0.38 gm (P c 0.01). No clot was present In HB and H76. After heparinization no blood clot was found in any mixtures of the catheter-syringe system. it Is concluded that unlike ionic contrast media, nonionic contrast agents appear to have less inhibitory effects on blood clot formation and, thus, it might be associated with a higher risk of thromboembollc complications during coronary angiography. Since heparin inhibits clotting in the presence of nonionic medium, its use is particularly recommended when this medium is to be used In coronary angiography.