| ObjectiveTo retrospectively analyze the incidence and risk factors of contrast-induced acute kidney injury in patients with acute myocardial infarction after percutaneous coronary intervention,and explore the prevention and treatment strategies for contrast-induced acute kidney injury after PCI.MethodsA total of 594 patients who were diagnosed AMI and treated with PCI in the Department of Cardiology of the second affiliated Hospital of Shenyang Medical College from January 2015 to January 2021 were selected.The level of serum creatinine was measured routinely before and one week after operation.All patients were divided into CI-AKI group（51 cases）and non-CI-AKI group（543 cases）according to the difference of serum creatinine level and the diagnosis criteria of the clinical practice guidelines for acute renal injury issued by the improved Global Nephropathy prognosis Organization in 2012,and the baseline demographic characteristics,biochemical laboratory test results and PCI treatment were compared between the two groups.Binary Logistic regression model was used to analyze the risk factors of acute renal injury after percutaneous coronary intervention in patients with acute myocardial infarction,and the receiver operating characteristic curve was drawn to describe the area,sensitivity and specificity of neutrophil-to-lymphocyte,cystatin C and their combination to evaluate the energy efficiency of these indexes in predicting contrast-induced acute renal injury.ResultsOf the 594 patients enrolled in the study,51 developed contrast-induced acute renal injury,with an incidence of 8.58%.The history of hypertension,stroke,acute ST segment elevation myocardial infarction（STEMI）,Killip grade ≥ 2 and multi-vessel disease in CI-AKI group were significantly higher than those in non-CI-AKI group（all P<0.05）.There was no significant difference in sex,age,history of diabetes,hyperlipidemia,history of myocardial infarction,operation time,serum creatinine,urea nitrogen,uric acid,hemoglobin and red blood cell distribution widththe between two groups（P > 0.05）.The levels of NLR,platelet-to-lymphocyte ratio（PLR）,CysC and N-terminal pro B type natriuretic peptide（NT-pro BNP）in CI-AKI group were significantly higher than those in non-CI-AKI group,while estimated glomerular filtration rate（e GFR）,left ventricular ejection fraction（LVEF）,Contrast medium dose and operation time were significantly lower than those in non-CI-AKI group.Multivariate Logistic regression analysis showed that NLR（OR= 1.225,95%CI:1.057 ～ 1.418,P=0.007）,e GFR（OR=1.036,95%CI: 1.007 ～ 1.065,P =0.016）,CysC（OR=15.219,95%CI:4.689 ～ 49.395,P<0.001）,Killip grade ≥2（OR= 5.607,95%CI: 2.606 ～ 12.063,P < 0.001）and multi-vessel lesions（OR=8.967,95%CI:1.789～44.923,P=0.008）were independent risk factors for the occurrence of CI-AKI in patients with acute myocardial infarction after PCI.ROC curve analysis showed that the area under curve（AUC）of NLR in predicting CI-AKI after PCI was 0.728,and the sensitivity and specificity were 0.627 and 0.786,respectively.The AUC of CysC for predicting CI-AKI was 0.777,and the sensitivity and specificity were 0.824 and 0.573,respectively.The AUC of CysC and CysC for predicting CI-AKI was 0.853,and the sensitivity and specificity were 0.804 and 0.788,respectively.Conclusions1.The occurrence of CI-AKI is the result of multiple risk factors,NLR,e GFR,CysC,Killip grade ≥ 2 and multi-vessel disease are independent risk factors for CI-AKI after PCI in patients with acute myocardial infarction.2.Higher preoperative NLR and CysC levels have higher predictive value for CI-AKI in patients with acute myocardial infarction after PCI,and their combined diagnosis of CI-AKI has higher efficiency. |
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