Incidence of contrast-induced acute kidney injury associated with diagnostic or interventional coronary angiography (original) (raw)
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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.
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.
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;
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.
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.
EuroIntervention, 2014
Contrast-induced nephropathy (CIN) is a leading cause of morbidity and mortality in patients undergoing percutaneous coronary intervention (PCI). Limited data, however, are available on predictors of CIN in PCI for chronic total occlusion (CTO) lesions. The aim of the study was to determine the risk of developing CIN in patients undergoing CTO PCI by studying the effects of clinical variables, interventional techniques, and CTO lesion characteristics on renal function. Methods and results: This retrospective analysis included consecutive patients referred for CTO PCI between January 2002 and December 2009. CIN was defined as an elevated serum creatinine level ≥25% of baseline serum creatinine level at 48-72 hours after procedure. Patient characteristics, Mehran score, lesion characteristics, interventional procedure, and devices used were compared between CIN and non-CIN groups. For the 516 patients eligible for analysis, the incidence of CIN was 5.4% (28/516). Two patients needed transient haemodialysis (0.4%, 2/516). Analysis of risk using Mehran scoring found that the incidence of CIN was 0.5% (1/207) among low-risk patients, 3.4% (7/205) among moderate-risk patients, 15.9% (14/88) among high-risk patients and 37.5% (6/16) among very high-risk patients. The Mehran score high-risk group (11-15) and the very high-risk group (≥16) were definitely predictors of CIN after CTO PCI (OR: 27.022 [95% CI: 2.787-262.028, p=0.004]; OR: 32.512 [95% CI: 2.149-491.978, p=0.012]). Severe tortuosity was the only predictor of CIN after CTO PCI in angiographic and procedural findings (OR: 6.621 [95% CI: 1.090-40.227, p=0.040]). Conclusions: Being in the Mehran score high-risk group (11-15) or the very high-risk group (≥16) and severe tortuosity were predictors of CIN after CTO PCI.
Journal of the American College of Cardiology, 2004
A simple risk score for prediction of contrast-induced nephropathy after This information is current as of OBJECTIVES We sought to develop a simple risk score of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). BACKGROUND Although several risk factors for CIN have been identified, the cumulative risk rendered by their combination is unknown.
Revista portuguesa de cardiologia, 2018
Introduction: Individuals with glomerular filtration rate (GFR) ≥60 ml/min/1.73 m 2 estimated by the Cockcroft-Gault formula (CG) who undergo percutaneous coronary intervention (PCI) frequently develop contrast-induced nephropathy (CIN). This study aimed to assess whether individuals with significant renal impairment assessed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, but not by CG, more often develop CIN following PCI than those without renal impairment by either formula. Methods: In this cross-sectional study analyzing patients with baseline CG GFR ≥60 ml/min/1.73 m 2 before PCI, subjects were divided into two groups according to CIN occurrence. Baseline CKD-EPI GFR was calculated for all patients. Results: We analyzed 140 patients. Baseline GFR was 87.5±21.3 and 77.1±15.0 ml/min/1.73 m 2 for CG and CKD-EPI, respectively. CIN occurred in 84.6% of individuals with baseline CKD-EPI GFR <60 ml/min/1.73 m 2 vs. 51.1% of those without. Males and those with higher body mass index were more likely to present baseline CKD-EPI GFR <60 ml/min/1.73 m 2 (p=0.021). Nonionic contrast agent use and baseline CKD-EPI GFR ≥60 ml/min/1.73 m 2 were protective factors against CIN. Greater amounts of contrast agent and acute coronary syndrome were associated with higher CIN risk. In subjects with serum creatinine <1.0 mg/dl, GFR was more likely to be overestimated by CG, but not by CKD-EPI (sensitivity 100.0%; specificity 52.0%).