| Objective:A retrospective analysis was conducted on 1070 patients with acute myocardial infarction undergoing PCI,and statistical analysis was conducted on the risk factors for CIN and perioperative prognosis.Exploring the risk factors and perioperative prognosis of contrast-enhanced nephropathy(CIN)after treatment for acute myocardial infarction(AMI).Method:A total of 1070 patients with acute myocardial infarction who underwent emergency PCI in the Department of Cardiology of jiangsu University Hospital between January 2018 and March 2022 were retrospectively reviewed,and the admission criteria were: 1.Patients who meet the diagnostic criteria for acute myocardial infarction and undergo emergency PCI surgery.Exclusion criteria:(1)patients with allergic reactions to iodine or iodinated contrast media;(2)Patients with chronic renal insufficiency stage 5 or maintenance hemodialysis / peritoneal dialysis;(3)Patients with incomplete collection of clinically important data;(4)Women who were lactating or pregnant;(5)Severe inflammatory disease,autoimmune disease,liver dysfunction and previous renal transplant patients.Clinical data and laboratory tests of patients were collected,divided into CIN and non CIN groups according to whether CIN occurred or not,and then the risk factors and perioperative prognosis of CIN occurrence were investigated.Result:Among the 1070 patients included,105 had CIN,with an incidence rate of 9.8%;There was no statistically significant difference in hypertension between the CIN group and the non CIN group [75(71.4%)vs 658(68.2%)P=0.497];Compared with the non CIN group,the type of myocardial infarction [69(65.7%)vs 526(54.5%)P=0.028],hemoglobin [129.2 ± 20.3 vs 135.0 ± 21.2 P=0.009],age [68.7 ± 13.2 vs64.7 ± 12.5 P=0.002],left ventricular Ejection fraction(LVEF%)[57.7 ± 10.4 vs 61.2± 9.8 P=0.001],Glycated hemoglobin [7.4 ± 2.5 vs 6.7 ± 1.6 P=<0.001],perioperative death [11(10.5%)vs 8(0.8%)P=<0.001] In hospital Acute kidney injury [42(40.0%)vs 5(0.5%)P=<0.001],gender [61(58.1%)vs 741(76.8%)P=<0.001],history of drinking [15(14.4%)vs 232(24%)P=0.027],history of diabetes [46(43.8%)vs 303(31.4%)P=0.010],left anterior descending artery disease [102(97.1%)vs 873(90.5%)P=0.022],the difference was statistically significant(P<0.05).CIN group had more proportion of acute ST elevation myocardial infarction,older age,more female patients,more proportion of patients with diabetes mellitus,less history of alcohol consumption,lower hemoglobin,smaller LVEF(%),more left anterior descending artery disease,more perioperative death,more in-hospital acute renal failure,with statistical significance(P < 0.05),and multiple logistic regression analysis,Myocardial infarction type(OR = 0.774,95%CI: 0.616-0.973,P = 0.028),glycated hemoglobin(OR = 1.221,95%CI: 1.060-1.407,P = 0.006),left ventricular ejection fraction(LVEF%)(OR = 0.971,95%CI: 0.952-0.991,P = 0.004),gender(OR = 0.461,95%CI:0.270-0.785,P = 0.004)were independent risk factors for developing CIN(P < 0.05);According to the results of the histogram,in the low Glycated hemoglobin group,the proportion of women and men who have CIN in the total number of their respective sexes is 7.03% and 2.88% respectively;In the middle Glycated hemoglobin group,the proportion of women and men with CIN in the total number of their respective sexes was 2.96% and 2.04% respectively;In the high glycosylated hemoglobin group,the proportion of women and men with CIN in the total number of each sex was 5.92%and 2.16% respectively.According to the bar chart results,in the low age group,the proportion of women and men with CIN in the total number of people of their respective genders is 0% and 0.36%,respectively;In the middle age group,the proportion of women and men with CIN in the total population of their respective genders is 2.22% and 2.40%,respectively;In the elderly group,the proportion of women and men with CIN in the total number of individuals of their respective genders is 14.06% and 4.56%,respectively.According to the bar chart results,in the group with 1 coronary artery lesion,the proportion of women and men with CIN in the total number of individuals of their respective genders was 2.59% and 1.20%,respectively;In the group of 2 coronary artery lesions,the incidence of CIN in females and males was 2.59% and 1.32%,respectively;In the group of three coronary artery lesions,the proportion of women and men with CIN in the total number of individuals of their respective genders was 11.10% and 4.80%,respectively.The Receiver operating characteristic of Glycated hemoglobin to predict CIN,the area under the curve(AUC)was 0.568(P=0.023),95% CI: 0.504-0.633.When Glycated hemoglobin>8.85% was taken as the cut-off value of CIN,the sensitivity and specificity of Glycated hemoglobin to predict CIN were 24.5% and 90.4%respectively;LVEF(%)predicted the Receiver operating characteristic of CIN,and the area under the curve(AUC)was 0.605(P=0.001),95% CI: 0.546-0.663.When LVEF(%)<60.5% was taken as the cutoff value of CIN,the sensitivity and specificity of LVEF(%)to predict CIN were 54.6% and 63.1% respectively;In which perioperative death occurred in 10.48% of the CIN group compared with 0.83% in the non CIN group,the difference was statistically significant(P < 0.05).The rate of developing in-hospital acute renal failure was 40.0% in the CIN group compared with0.52% in the non CIN group,and the difference was statistically significant(P < 0.05).Conclusions:Patients with acute ST segment elevation myocardial infarction,female gender,high glycated hemoglobin and low LVEF(%)levels were more likely to develop CIN,and patients who developed CIN had a worse perioperative prognosis. |
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