Risk Factor Analysis For Contrast-induced Nephropathy In Patients Of Acute Coronary Syndrome With Normal Or Slightly Impaired Renal Function After Percutaneous Coronary Intervention

Objective:(1). To research the risk factors for contrast-induced nephropathy(CIN) in patients of acute coronary syndrome(ACS) with normal or slightly impaired renal function after percutaneous coronary intervention(PCI).(2). To analyze the correlation of NT-pro BNP and nephropathy(CIN).Methods:A total of 300 consecutive ACS patients with normal or slightly impaired renal function received PCI in cardiovascular department of The rockets army general hospital from 2013-01 to 2016-01 were retrospectively studied.Inclusion criteria:ACS(AMI(STEMI+NSTEMI)+UA),and e GRF≥60 ml/(min·1.73m2).exclusion criteria:Clinical data is imperfect,pregnancy,Serious cardiac insufficiency,chronic respiratory disease,Severe renal insufficiency,renal transplantation,kidney dialysis,Using renal protection and damage drugs,thyroid malfunction,contrast agent irritability and has used contrast agent in seven days.All patients had e GRF≥60 ml/(min·1.73m2) and they were divided into 2 groups:CIN group, the patients with serum creatinine increased by 0.5mg/dl(44.2μmol/L) or elevated to 25% higher than the baseline, n=28; Non-CIN group, n=272.Details to be included in the general date,including age,gender,smoking history,Anamnesis,laboratory tests and operative indexes.To compare the clinical date of patients,NT-pro BNP,and hospitalization period of major adverse events(malignant arrhythmia,recurrent myocardial infarction,cardiac failure,kidney failure,death),to analyze the correlation of NT-pro BNP and nephropathy(CIN).All date using SPSS 17.0.software is analyzed,and P<0.05 considered statistically significant.Results:(1)There were 9.3%(28/300) patients suffered from CIN after PCI.(2)The complication of CIN and Non-CIN:elder[(68.72±4.89)vs(62.03±11.38)],lower systolic pressure and diastolic pressure[(108.58±12.37)mm Hg vs(130.64±12.12)mm Hg(1 mm Hg=0.133 k Pa)and(66.08±11.28)mm Hg vs(79.18±11.56)mm Hg],renal insufficiency,diabetes,Postoperative hypotension,no regular use statins or aspirin,st-elevation myocardial infarction and non-ST elevated myocardia infarction,emergency PCI,the differences are statistically significant(P<0.05).And the high risk group is higher log NT-pro BNP,UA and lower e GFR,TG and LVEF. Differences between the two groups were not significant on sex,weight,smoking,hyperlipemia,the position and quantity of coronary arteries,and dosage of contrast agent.(3)Multivariate regression analysis indicated:The emergent PCI(OR=7.948, 95% CI1.113-57.045),Postoperative hypotension(OR=1.198,95%CI:1.063~1.919),diabetes(OR=1.690,95%CI: 1.172~4.815)and without pre-operative aspirin administration(OR=0.392,95%CI: 0.059-0.588)were the clinical risk factors for post-operative CIN occurrence,and NT-pro BNP(OR=4.213, 95% CI 1.216-14.756) has correlation with CIN.Conclusion:Emergent PCI,Postoperative hypotension,diabetes and no pre-operative aspirin administration were the risk factors for CIN occurrence in ACS patients with normal or slightly impaired renal function after PCI,and NT-proBNP has correlation with CIN.