Correlation Study Of Contrast-induced Nephropathy After Percutaneous Coronary Intervention For Coronary Heart Disease

Background.Contrast-induced nephropathy(CIN)is associated with significantly increased major adverse cardiovascular events(MACES)after percutaneous coronary intervention(PCI)for coronary artery disease.At present,there is no unified definition for the diagnosis standard of CIN.Different definitions adopted by different research institutes bring confusion to the research in this field,and also bring some problems to the clinical application.The purpose of this study was to evaluate the clinical characteristics and postoperative adverse event correlation between the two diagnostic criteria of CIN.Methods.From January 2013 to December 2013,10394 patients undergoing PCI in Fuwai Hospital were analyzed retrospectively.Incidence and long-term MACEs of CIN were assessed according to two different definitions:the CIN25%definition from Guidelines for contrast media from the European Society of Urogenital Radiology in 2003 as an increase in serum creatinine ≥25%or≥0.5 mg/dl(44.2 μ mol/L)from baseline within 48 hours after PCI,and the CIN50%definition according to kidney disease improving global outcomes(KDIGO)in 2012 as an incr ease in serum creatinine ≥ 50%or≥0.3mg/dl(26.5 μ mol/L).The incidence of CIN and the risk of major adverse events(MACEs)in 2-year follow-up with two CIN definitions after PCI were compared.Results.A total of 10394 patients were enrolled.The median follow up period was 753 ± 54 days.There was a significant difference(P<0.001)between 936 cases(9.0%)with CIN25%definition and 206 cases(2.0%)with CIN50%definition.Compared with the CIN patients with CIN50%definition,the CIN patients with CIN25%definition had higher estimated glomerular filtration rate(eGFR)and lower serum creatinine before PCI,and the proportion of patients with Chronic kidney disease(CKD)stage 1 was significantly higher.The incidence of MACEs was 11.7%(24)and 11.9%(1216)in CIN patients of CIN25%definition and CIN50%definition,respectively.There was no significant difference in the incidence of MACEs(9.9%vs 11.7%,P=0.463).Cox multivariate regression analysis showed that the CIN determined by the two criteria were not independent predictors of MACEs.Left ventricular ejection fraction,PCI history,diabetes history,hypertension history,SYNTAX score and IABP were independent predictors of MACEs in 2 years.Conclusions.In patients treated by PCI,the CIN rates of CIN25%and CIN50%definition were different.CIN determined by the two criteria were not independent predictors of MACEs after PCI.Left ventricular ejection fraction,PCI history,diabetes history,hypertension history,SYNTAX score and IABP were independent predictors of MACEs 2 years after PCI.Background:Chronic total occlusion(CTO),defined as a complete occlusion of a coronary vessel of>3 months duration,is a common finding after routine coronary angiography,with a prevalence between 18 and 52%.With the continuous advancement of coronary interventional technology and equipment,more and more patients with chronic total obstructive coronary disease(Chronic total occlusion,CTO)have undergone interventional treatment.However,the operation of CTO patients is difficult,the incidence of complications is high,and the amount of contrast agent is large.However,currently,there is still a lack of large-scale real-world clinical data on whether the risk of contrast agent nephropathy increases correspondingly after CTO patients undergo interventional treatment.OBJECTIVE:This study was to investigate correlation between contrast-induced nephropathy and Chronic total occlusion coronary interventional therapy by a single-center obserbvational study.METHODS:Through a single-center observational study,all patients undergoing coronary intervention in Fuwai Hospital in 2013 were divided into the CTO group and the non-CTO group.The incidence of contrast agent nephropathy and its risk factors were analyzed by matching the propensity scores.RESULTS:This study was a single-center,prospective,observational study,a total of 9,924 patients(excluding patients younger than 18 years old and missing creatinine and contrast agents before and after surgery)were enrolled,with 876 CTO patients and 9048 non-CTO patients.The incidence of contrast induced nephropathy was 2.2%vs 1.8%in CTO and non-CTO patients,respectively(P=0.454).After Propensity score matching,the incidence of contrast-induced nephropathy in the CTO group(850 patients)and the non-CTO group(850 patients)was 2.2%and 1.4%,P=0.204,respectively.After multivariate analysis,CTO was not an independent risk factor for CIN(P>0.05),before and after the propensity score matching.Before propensity score matching,multivariate analysis showed that:≥75 years old(orl.168,P=0.024),left ventricular ejection fraction(OR0.957,P<0.001)and anemia(0R1.150,P=0.030)were independent predictors of contrast independent nephropathy.After propensity score matching,only>75 years old was independent predictor of CIN(P=0.028).CONCLUSIONS:Patients with CTO and non-CTO have a comparable risk of contrast-induced nephropathy after percutaneous coronary intervention therapy.≥ 75 years old was independent predictor of CIN.Background:Contrast induced nephropathy(CIN)is one of the common complications of coronary interventional therapy,which often increases the length of hospital stay.At present,sufficient hydration,reducing the amount of contrast agent and avoiding the use of high-osmolar contrast agent are effective prevention methods.The use of low-osmolar and iso-osmolar contrast agents has significantly reduced the incidence of CIN.At the beginning of the application of iso-osmolar contrast agents,it is generally believed that iso-osmolar conditions can reduce the incidence of contrast nephropathy,but more and more various clinical studies on iso-osmolar contrast agents and low-osmolar contrast agents have not yet reached a unified conclusion.Objectives:This study investigated the correlation between iso-osmolar/low-osmolar contrast agents and contrast-induced nephropathy and long-term prognosis after interventional therapy for coronary heart disease.Methods:This study was a single-center,prospective,observational study.The study included all patients who underwent percutaneous intervention(PCI)in our hospital from January 1,2013 to December 31,2013,excluding patients younger than 18 years old,missing creatinine and the amount of contrast agent,and in-hospital death.A total of 9,903 patients were analyzed.According to the type of contrast agent used,it is divided into the iso-osmolar contrast agent group(n=1 691)and the low-osmolar contrast agent group(n=8 212).The effects of the use of iso-osmolar and low-osmolar contrast agents on the incidence of CIN and 2-year long-term prognosis were analyzed.Results:The incidence of CIN in patients with iso-osmolar contrast group and low-osmolar contrast group was 6.2%and 9.0%,respectively,and the difference was statistically significant(P<0.001).Multivariate analysis of adjusted age,gender,diabetes,acute ST-elevation myocardial infarction,preoperative eGFR,left ventricular ejection fraction,contrast agent dosage,and Mehran score showed that the application of iso-osomar contrast agents is always an independent predictor of CIN(OR=0.629,95%CI:0.495～0.799,P<0.001).The 2-year all-cause deaths in the iso-osmolar contrast group and the low-osmolar contrast group were 30(1.8%)and 69(0.8%),respectively.The log-rank analysis showed that there is a statistical difference between the two groups(P<0.001).Cox regression analysis was used to analyze the predictors of 2-year all-cause mortality,the adjusted variables included were age,gender,type 2 diabetes,smoking,acute ST-segment elevation myocardial infarction,preoperative eGFR,Syntax score,and left ventricular ejection Score,isotonic contrast agent,contrast agent nephropathy,and Mehran score.Compared with low-osmolar contrast agent,iso-osmolar contrast agent is not an independent risk factor for all-cause death in 2 years(HR=0.744,95%CI:0.438～1.263,P=0.273).Conclusions:Compared with low-osmolar contrast agents,iso-osmolar contrast significantly reduced the incidence of contrast induced nephropathy after percutaneous coronary intervention,but had no significant effect on 2-year all-cause mortality.