Abstract 1694: Reduced Incidence of Contrast Induced Nephropathy after Percutaneous Coronary Intervention with Routine Use of Visipaque in Unselected Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jonas Eichhöfer ◽  
Joan Ivanov ◽  
Mark Osten ◽  
Karen Mackie ◽  
Vladimir Dzavik
Keyword(s):  
Contrast Agent ◽  
Propensity Scores ◽  
Multivariate Logistic Regression Analysis ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Contrast Induced Nephropathy ◽  
Data Registry ◽  
Period 2 ◽  
Cardiac Centre ◽  
Risk Patients

Objective: An observational study to determine if the routine use of Visipague contrast solution was associated with a decreased incidence of contrast-induced nephropathy (CIN) in patients following PCI at a large, tertiary cardiac centre. Methods: The Toronto General Hospital Interventional Cardiology Program maintains a prospective registry of all PCI procedures12951 consecutive patients undergoing PCI from a prospective data registry were assigned to either Period 1 (2000 – 03, various contrast agents were utilized) or Period 2 (2003– 06, only Visipaque was used). The contrast agent was changed systematically to the iso-osmolar agent, Visipaque. CIN was defined as an increase in plasma creatinine of >25% within 24 hours following PCI. Using propensity scores, 2502 consecutive patients undergoing PCI in Period 1, were randomly matched to 2502 patients in Period 2. Multivariate logistic regression analysis was used to identify the independent predictors of CIN. Results: The two well matched cohorts showed no significant differences in major pre-procedure clinical variables. Visipaque was associated with a lower rate of CIN after PCI (Period 1 = 14%, Period 2 = 7%, p<0.001). The multivariate independent predictors of CIN were: Visipaque (OR 0.437, p<0.001), contrast media volume per 10 ml (OR 1.015; p<0.0001), pre-procedure creatinine per 10mmol/L (OR 1.013; p=0.003), ACS (OR 2.861; p <0.001), PCI following thrombolysis (OR 1.952; p=0.022), peripheral vascular disease (OR 1.375; p=0.023), and age per decade over 40 (OR 1.143; p=0.001) Conclusions: After adjusting for significant predictors of CIN, a strategy of routine use of an iso-osmolar contrast agent (Visipaque) appeared to be associated with a lower risk of developing CIN after PCI, especially in higher risk patients. Contrast volume, ACS and age were the most powerful predictors of development of contrast nephropathy.

scholarly journals Incidence and Predictors of Contrast Induced Nephropathy after Coronary Intervention at College of Medical Sciences Teaching Hospital, Bharatpur

2014 ◽  
Vol 11 (1) ◽  
pp. 3-11
Author(s):  
Sanjib Kumar Sharma ◽  
Laxman Dubey ◽  
Shankar Laudary ◽  
Sachin Dhungel ◽  
Madhav Ghimire ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Contrast Agent ◽  
Multivariate Logistic Regression Analysis ◽  
Sampling Technique ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Contrast Induced Nephropathy ◽  
Creatinine Concentration ◽  
Disease Study

Background and Aims: The implications of radio-contrast induced nephropathyare disastrous. In Nepal there is scarcity of data on contrast induced nephropathy. This observational descriptive study was undertaken to study the incidence of contrast induced nephropathy and to identify risk factors (predictors) for the development of contrast induced nephropathy in patients undergoing coronary angiography and angioplasty in atertiary care hospital. Methods: The subject consists of 540 patients undergoing coronary intervention from 2011 to 2013 were enrolled by convenient sampling technique. Two hundreds ten patients were excluded from the study. Therefore, a total of 330 patients were studied and analyzed. Contrast induced nephropathy was defined as an increase of >25% or >0.5 mg/dl in pre-catheterization serum creatinine at or after 48 h after percutaneous coronary intervention. Estimated glomerular filtration rate as calculated by applying the 4 variables Modification of Diet in Renal Disease Study equation. Standard definitions were used to define the variables. Results: Twenty seven (8.18%) patients experienced contrast induced nephropathy. The incidence of contrast induced nephropathy in patients with baseline creatinine clearance <60 ml/min was 45.9%. Contrast induced nephropathy developed in 10% of anemic and 12.5% diabetic patients. The amount of the contrast agent administered was similar for both groups of patients (138.20±91.34ml vs. 175.56±118.86ml; p =0.254). No correlation was found between the amount of contrast agent administered and the change of serum creatinine concentration. Multivariate logistic regression analysis found that baseline e-GFR and baseline hemoglobin were independent predictors for Contrast induced nephropathy. Conclusion: The overall incidence of Contrast induced nephropathy after coronary intervention in this study is high. Patients with both preexisting renal insufficiency and anemia were at high risk of Contrast induced nephropathy. DOI: http://dx.doi.org/10.3126/njh.v11i1.10975 Nepalese Heart Journal 2014;11(1): 3-11

Downsizing – the Future of Interventional Cardiology

2012 ◽  
Vol 7 (1) ◽  
pp. 28
Author(s):  
Giovanni Amoroso ◽  
Keyword(s):  
Contrast Agent ◽  
Vascular Complications ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Transradial Approach ◽  
Technical Developments ◽  
Coronary Procedures ◽  
Angiographic Image

The concept of downsized catheters (i.e., using catheters smaller than 6 French) for invasive coronary procedures, such as diagnostic cardiac catheterisation and percutaneous coronary intervention, has been developing over the years, particularly as a result of the rise of the transradial approach. Recent advances have allowed the use of smaller and sheathless catheters, which confer a number of advantages – such as fewer vascular complications, reduced use of contrast agent and reduced haemostasis – thus increasing patient safety and comfort and allowing more rapid patient mobilisation. Reductions in patient complications, number and length of hospital stay, and amount of contrast agent used can also lead to cost savings. While the use of smaller catheters has been hindered in the past because of poor angiographic image quality, new automated contrast injectors have helped overcome this limitation. There is a need to make interventional cardiologists worldwide more aware of the benefits of downsizing, in the light of the latest technical developments and the increased use of transradial approach.

scholarly journals Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

2010 ◽  
Vol 2010 ◽  
pp. 1-12 ◽  
Author(s):  
Sana Shoukat ◽  
Saqib A. Gowani ◽  
Asif Jafferani ◽  
Sajid H. Dhakam
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Renal Tissue ◽  
Therapeutic Interventions ◽  
Contrast Induced Nephropathy ◽  
Iodinated Contrast ◽  
Percutaneous Coronary ◽  
Direct Cytotoxicity ◽  
Risk Patients ◽  
Radiological Procedures

Contrast Induced Nephropathy (CIN) is a feared complication of numerous radiological procedures that expose patients to contrast media. The most notorious of these procedures is percutaneous coronary intervention (PCI). Not only is this a leading cause of morbidity and mortality, but it also adds to increased costs in high risk patients undergoing PCI. It is thought to result from direct cytotoxicity and hemodynamic challenge to renal tissue. CIN is defined as an increase in serum creatinine by either 0.5 mg/dL or by 25% from baseline within the first 2-3 days after contrast administration, after other causes of renal impairment have been excluded. The incidence is considerably higher in diabetics, elderly and patients with pre-existing renal disease when compared to the general population. The nephrotoxic potential of various contrast agents must be evaluated completely, with prevention as the mainstay of focus as no effective treatment exists. The purpose of this article is to examine the pathophysiology, risk factors, and clinical course of CIN, as well as the most recent studies dealing with its prevention and potential therapeutic interventions, especially during PCI. The role of gadolinium as an alternative to iodinated contrast is also discussed.

MO416PREDICTORS OF CONTRAST-INDUCED NEPHROPATHY AND THE APPLICABILITY OF THE MEHRAN RISK SCORE IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Emna Chaabouni ◽  
Hela Jbali ◽  
Najjar Mariem ◽  
Mzoughi Khadija ◽  
Zouaghi Mohamed karim
Keyword(s):  
Coronary Angiography ◽  
Risk Score ◽  
Significant Risk ◽  
Risk Groups ◽  
Coronary Intervention ◽  
Contrast Induced Nephropathy ◽  
Cardiology Department ◽  
Risk Patients ◽  
Good Score ◽  
Poor Outcomes

Abstract Background and Aims Contrast-induced nephropathy (CIN) after coronary angiography (CAG) is associated with poor outcomes. The purpose of our study was to identify predictors of CIN in patients undergoing CAG and to evaluate the applicability of the Mehran Risk Score (MRS) in the prediction of CIN in our population. Method We prospectively enrolled 158 patients who underwent coronary angiography with or without percutaneous coronary intervention from December 2017 to February 2018 at a cardiology department . CIN was defined as an increase in serum creatinine level &gt;25% or 0.5 mg/dL after 48 hours postcardiac catheterization. The patients who developed CIN were then analysed for the presence of specific risk factors. The patients were categorized into the 4 risk groups based on the MRS. Results The incidence of CIN was 9,5%. On multivariate analysis, the presence of anemia (p = 0.043), toxic contrast dose (as defined by ratio volume of contrast media to estimated glomerular filtration rate (V/eGFR) &gt; 2) (p = 0.02) and chronic renal failure (p = 0.026) were independently found to confer a significant risk of CIN. In patients belonging to the high Mehran risk group (MRS10- 15) the risk of CIN was 3,7 fold (OR: 3.7, 95% CI: 0,88–15,6, p = 0.036) higher when compared to intermediate and low risk patients (MRS &lt;10). Conclusion Mehran risk score is as a good score for predicting CIN in patients who underwent coronary angiography. According to this, we support its use in order to identify the ones at risk, and to optimize CIN prophylactic therapy prior to and after catheterization.

Can Thrombus Burden Predict Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction?

Angiology ◽  
2019 ◽  
Vol 70 (7) ◽  
pp. 642-648 ◽  
Author(s):  
Serhat Sigirci ◽  
Kudret Keskin ◽  
Süleyman Sezai Yildiz ◽  
Gökhan Cetinkal ◽  
Ahmet Gurdal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Multivariate Logistic Regression Analysis ◽  
Coronary Intervention ◽  
Contrast Induced Nephropathy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
The Impact

The incidence of contrast-induced nephropathy (CIN) increases in the range from patients with unstable angina to ST-segment elevation myocardial infarction (STEMI). Platelet activation has been associated with pathophysiology of nephropathy and thrombus burden in the infarct-related arteries. We investigated the impact of thrombus burden on CIN in patients with STEMI. We enrolled 883 patients with STEMI who received primary percutaneous coronary intervention. Patients were divided into groups according to thrombus burden and CIN development. Thrombus burden was scored based on thrombolysis in myocardial infarction thrombus grades (TGs). Thrombus grade 4 was defined as large thrombus burden (LTB), while thrombus burden <TG 4 was defined as small thrombus burden. A total of 126 (14.2%) patients with STEMI had CIN, while 313 (35.4%) patients had LTB. Compared to CIN (−) patients, CIN (+) patients were older, had lower hemoglobin levels, lower ejection fraction, and higher contrast media volume administration. Multivariate logistic regression analysis demonstrated that LTB, age, hypertension, and admission glomerular filtration rate were independent predictors of CIN ( P = .016, P < .001, P = .028, P < .001, respectively). Thrombus burden, which is measurable during angiography, may be helpful in the determination of CIN risk in patients with STEMI.

Association of monocyte to HDL cholesterol level with contrast induced nephropathy in STEMI patients treated with primary PCI

2017 ◽  
Vol 55 (1) ◽  
pp. 132-138 ◽  
Author(s):  
Saim Sağ ◽  
Abdülmecit Yıldız ◽  
Aysel Aydin Kaderli ◽  
Bülent Cuma Gül ◽  
Ömer Bedir ◽  
...  
Keyword(s):  
Multivariate Logistic Regression Analysis ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Coronary Intervention ◽  
Cardiovascular Outcomes ◽  
Primary Pci ◽  
Contrast Induced Nephropathy ◽  
Intravenous Contrast ◽  
St Segment Elevation ◽  
St Segment

Abstract Background: Contrast induced nephropathy (CIN) has been proven to be a clinical condition related to adverse cardiovascular outcomes. In recent studies, the monocyte to high density lipoprotein ratio (MHR) has been postulated as a novel parameter associated with adverse renal and cardiovascular outcomes. In this study we investigated the association of MHR with CIN in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). Methods: Consecutive STEMI patients treated with primary PCI were prospectively recruited. Subjects were categorized into two groups; as patients who developed CIN (CIN+) and patients who did not develop CIN (CIN–) during hospitalization. CIN was defined as either a 25% increase in serum creatinine from baseline or 44.20 µmol/L increase in absolute value, within 72 h of intravenous contrast administration. Results: A total number of 209 patients were included in the study. Thirty-two patients developed CIN (15.3%). In the CIN (+) patients, monocytes were higher [1.02 (0.83–1.39) vs. 0.69 (0.53–0.90) 109/L, p<0.01] and HDL cholesterol levels were lower [0.88 (0.78–1.01) vs. 0.98 (0.88–1.14) mmol/L, p<0.01]. In addition, MHR was significantly higher in the CIN (+) group [1.16 (0.89–2.16) vs. 0.72 (0.53–0.95) 109/mmol, p<0.01]. In multivariate logistic regression analysis, MHR, Mehran score, AGEF score and CV/eGFR were independently correlated with CIN. Conclusions: Higher MHR levels may predict CIN development after primary PCI in STEMI patients.

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