The Effects And Analysis Of Low-osmolar Nonionic Contrast Medium On Renal Function In Acute Myocardial Infarction Patients Who Underwent Percutaneous Coronary Interventions

Background: Acute myocardial infarction(AMI) is one of the most common cardiovascular emergency, with high mortality, in emergency internal medicine. Percutaneous coronary intervention(PCI) is one of the most effective treatments to save the life of AMI. CIN is one of the major complications of PCI and an important factor of acute renal failure after PCI. Nowadays, lo-osmolar nonionic contrast medium has been widespread used in the coronary angiography. However, the research, which about the occurrence situation of CIN in AMI patients undergoing emergency PCI, is less.Objective: To understand the effect of low-osmolar nonionic contrast medium on renal function in patients with AMI after PCI. To explore the incidence rate of CIN, the change characteristics of serum creatinine and the risk factors for CIN. In order to take early intervention for high-risk patients.Methods: We enrolled 144 patients with acute ST-segment elevation myocardial infarction(STEMI) who underwent emergency PCI from October 2008 to January 2011 in China-Japan union Hospital of Jilin University.All patients were applied low-osmolar nonionic contrast medium (iodine profeta amine). Record age, sex, weight index, the original disease (hypertension, diabetes, hyperlipidemia, renal insufficiency, diabetic nephropathy, anemia), preoperative main index (hematocrit, LVEF), operation related material ( dosage of contrast medium, stents number, recanalization time), used drugs (Bayaspirin, beta blockers, ACEI, renal toxic drugs) and prognosis information (hospitalization days, major adverse events) etc. Measured serum creatinine,at preoperative and on the 2nd day, 4th day and 8th day after PCI, total four times. Record preoperative hematocrit and preventive measures during the hospital. CIN is defined as the use of contrast medium occurs within 72h after the serum creatinine increased SCr≥44.2μmol/L (or 0.5mg/d1) or more than 25% higher than the baseline. According to that, divided the patients into CIN group and the CIN group. To explore the incidence of CIN, make single-factor analysis on possible risk factors of CIN in both groups, and make Logistic regression analysis on risk factors to make clear the CIN independent risk factors. Compare emergency PCI related datas to determine whether the risk factors of existing surgery. Compare 3 times postoperate serum creatinine with preoperative to make sure the characteristics of postoperate serum creatinine. Finally, compare the adverse events occurred and hospital stays between two groups to determine the influence of CIN on prognosis.Results: CIN occurred in 30 patients out of 144 patients(102 male and 42 femal with average age 64.13±7.948 ) incidence rate of 20.83%; The incidence in CIN group (8 with pre-existing renal insufficiency, 6 with diabetic kidney disease, 15 with LVEF<40%), was significantly higer than in non-CIN group (P<0.05). The average contrast dosage in CIN group was 189.00±50.333ml, and 146.84±58.708ml in non-CIN group, the difference was statistically significant (P<0.05); CIN mortality rate and incidence of adverse events during hospitalization was significantly higher than non-CIN group, the difference was statistically significant (P<0.05). The level of serum creatinine found in patients with CIN preoperative increased on the 2nd day, reached peak on the 4th day, and almost recovered to preoperative levels on the 8th day. The single-factor analysis showed that renal insufficiency, diabetic nephropathy, low LVEF, LVEF<40%, low hematocrit, dosage of contrast medium, number of implanted stents and recanalization time are the CIN"s risk factors. Logistic regression analysis showed that renal insufficiency, contrast medium dosage, LVEF<40% and low preoperative hematocrit are independent risk factors of CIN.Conclusions:CIN are one of the common complications for AMI patients after emergency PCI. The level of serum creatinine found in patients with CIN group preoperative increased on the 2nd day, reached on the peak 4th day, and almost recovered to preoperative levels on the 8th day. Renal insufficiency, contrast medium dosage, LVEF<40% and low preoperative hematocrit are independent risk factors of CIN. Diabetes and application of IABP are risk factors. CIN extends the length of hospital stays, and increases the incidence of major adverse events during hospitalization, reach 23.3%.