A Study Of The Variation Of Renal Function In Acute Coronary Syndrome Undergoing Coronary Intervention And Contrast Induced Nephropathy(CIN) Related Risk Factors

Objective: By monitoring serum creatinine and cystatin C of patients with acutecoronary syndrome(ACS) who undergoing coronary angiography (CAG) andpercutaneous coronary intervention(PCI) during preoperative and the postoperative,according to the variation of postoperative and preoperative serum creatinine diagnosecontrast induced nephropathy(CIN), and analyze the related risk factors for CIN, makesure cys-c whether have predictive value for CIN patients after PCI. In order to providedata for the research progress of CIN, and provide new ideas for clinical work.Methods:Selection331ACS(including acute st-elevation myocardial infarction,acute non ST segment elevation myocardial infarction and unstable angina) patientswith CAG and PCI in our hospital as the research object from March2012to January2014. Radiography agent allergy, severe liver and kidney dysfunction, cancer, infectiousdiseases, severe cardiac dysfunction, application of renal toxicity of drugs, nearly onemonths after application of contrast agent and isolated coronary artery angiography, theamount of contrast agent100ml were excluded. Record eligible patients number, gender,age, preoperative serum creatinine, preoperative cys-c, acute coronary syndrome types,history of hypertension, history of diabetes, postoperative24hours or72hours of serumcreatinine and cystatin C, postoperative monitoring time, contrast agent volume; On thebasis of the MDRD formula Chinese data improved in patients with chronic kidneydisease calculation of eGFR. We divided the patients into CIN group (n=32) and non CIN group(n=299) according to the variation of postoperative and preoperative serum creatinine and the definition of CIN. All experimental data were analyzed with SPSS19.0software.All analyses were performed using two-sided tests, P <0.05was considered statisticallysignificant differences. The measurement data express with mean±standard deviation(X±S), count data express with percentage (%).Based on the test of normality andhomogeneity of variance test, comparing CIN group and non CIN group variables usingt-test or chi-square test. We used Multivariate Logistic regression analysis for the riskfactors of CIN. We analyzd cys-c and serum creatinine, CIN by the Spearman correlationanalysis.Results:1.general data of patientsIn331patients, including242cases of male (73.11%),(62.29±10.97) yearsold.32cases were diagnosticed CIN, the incidence rate was9.67%,including20cases ofmale(62.50%),(64.38±11.49) years old. By analyzing the difference between CINgroup and non CIN comparison: compared with the gender, age, age>75, history ofhypertension, preoperative serum creatinine contrast agent dose, eGFR, postoperativemonitoring time of CIN group and non CIN group show no statistical significance (P>0.05);But the diabetes, diabetic nephropathy, postoperative serum creatinine, acutecoronary syndrome types, renal dysfunction between two groups show significantstatistical diffrerences(P <0.05).2. Multivariate Logistic regression analysis show that acute coronary syndrometypes are independent risk factors of CIN. Acute myocardial infarction are moresusceptible to CIN between with Unstable angina.3.We discover a positive correlation between the Cys-c variety and SCr variety bySpearman rank correlation analysis, the correlation coefficient of0.505, P <0.001, havestatistical significance. We can think that the change of Cys-c and SCr in the samedirection;Because SCr can be used to diagnose CIN, Cys-c with similar to the value indiagnosis of CIN.Conclusion:1.Diabetes, diabetic nephropathy, acute coronary syndrome type, renal function insufficiency is an influence factor of CIN.2.Acute myocardial infarction are more susceptible to CIN between with Unstableangina after PCI.3. A positive correlation between the Cys-c and SCr, Cys-c can be used to predict theoccurrence of CIN.