| Background:With the development of enhanced computed tomography(CT),coronary angiography(CAG) and percutaneous coronary intervention(PCI), the application of contrast agent is gradually increased in clinical and contrast-induced nephropathy(CIN) caused by contrast agents are increasingly causing clinicians attention. CIN was defined as an acute kidney injury that occurs within 48-72 hours of exposure to iodinated contrast media that cannot be attributed to other causes.The renal function impairment is mirrored by an absolute increase by 0.5mg/d L(or greater) or relative increase by 25%(or greater) of serum creatinine from baseline.The kidney injury caused by contrast agents showed more non-oliguric acute renal insufficiency. Scr typically rises with within the fisrt 24-48 hours after exposition, peaks on the 3-5 days, and returns to baseline within 10-14 days. CIN has become the third most common cause of iatrogenic renal failure, and 11% of hospital-acquired renal insufficiency cases are due to contrast media. It has been proved that CIN can not only prolong hospitalization, increase cost,but also increase requirement for dialysis and mortality. At present adequate hydration is recognized as an effective measure to prevent CIN.As the difference of first medical contact,individual and patient’s condition, multiple injections of contrast media within a short period of time is not rare in clinic. Some researchers suggested that the interval between procedures should be 2 weeks, the espected recovery time of the kidney after injury. However, some believed that the intervals should be more than seven days. The expert consensus about the clinical application of iodinated contrast agents in cardiovascular disease(2012) recommended that the interval between procedures should be at least greater than 72 h in patients with chronic kidney disease and diabetic nephropathy, and the consensus didn’t make a clear recommendation for other patients.The problem about the appropriate minimum time interval between procedures have no clear conclusion.Objective:The aim of this study is to discuss the impact on renal function in patients who were undergoing coronary angiography(CAG) or percutaneous coronary intervention(PCI) after coronary enhanced computed tomography(CT) within 1 weeks, and further evaluate the safety and feasibility of this procedure.Methods:1 Objects of study: A total 258 patients who were undergoing CAG or PCI after coronary enhanced computed tomography(CT) between November 2014 and August 2015 in the NO.1 central hospital of baoding were enrolled in the study. They were selected randomly divided into two groups. Patients in the test group were undergoing coronary angiography or PCI within 1 weeks. The interval is 1-2 weeks in control group.2 Methods: General conditions including age, gender, weight, underlying dieases etc were collected in all the patients. In accordance with Mehran score to stratify the risk of CIN. All patients received 0.9% Na Cl with 1.0-1.5ml/kg/h for 3h before and 12 h after contrast media administration. Serum creatinine(Scr), serum cystatin C(Cys C), and estimated glomerular filtration rate(e GFR) were collected before and at 1d, 2d, 3d after CAG or PCI to estimate the incidence of CIN. Contrast nephropathy is defined as an absolute increase by 0.5mg/d L(or greater) or relative increase by 25%(or greater) of serum creatinine within 48-72 hours after contrast media exposure.3 Statistical analysisAll data use SPSS17.0 software for statistical analysis. Measurement data was espressed as mean ± standard deviation, and the t-test, t’-test, or nonparametric-test was used to compare the intergroup difference. Enumeration data was espressed as rate(%), and the χ2 test or Fisher probabilities was adopted to compare the intergroup difference. Using the method of Pearson analysis the association between Cys C level and Scr, e GFR. Multivariate Logistic regression was used to identify the risk factors of CIN. P<0.05 was considered statistically significant.Results:1 A total of 258 eligible patients were randomly assigned to either the test group(n=132) or contral group(n=126).The interval between procedures is 4.43±1.12 days in test group, and the interval is 9.90±2.91 days in contral group. Clinical situations, gender, age, weight and height, diabetic patients, the dose of contrast media, with PCI surgery patients, Mehran score, have no significant difference between test group and the control group(P>0.05).2 The level of Serum Cys C was positively correlated with serum creatinine level(r=0.421,P<0.01), and negatively correlated with e GFR(r=-0.541,P<0.01).3 There was no significant differdnce between test group and control group in Scr, Cys C, and e GFR before and 1d, 2d, 3d after CAG or PCI(P>0.05). The Cys C level 1d, 2d, 3d after CAG or PCI was significantly higher when compared with before(P<0.05). However, the changes of Scr and e GFR have no significant difference(P>0.05).4 There was no significant difference between test group(5.30%) and control group(4.76%) in the incidence of CIN(P>0.05).5 Multiple Logistic regression showed that advanced age(OR=9.945,95%CI 1.783-55.481,P=0.009),a large of contrast volume(OR=11.893,95%CI 1.202-117.676,P=0.034), a higer Mehran score(OR=22.600,95%CI 4.031-126.712,P<0.001) were independent risk factors of CIN. Repeated application of contrast media within 1 week was not a risk factor of CINConclusion:1 It is safe and feasible for patients with e GFR≥60 ml/min/1.73m2 who were undergoing coronary angiography or PCI after coronary enhanced CT within 1 week.2 Advanced age, the amount of CM and Mehran score were individual risk factors of CIN.Repeated application of contrast media within 1 week was not a risk factor of CIN. |
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