Abstract 3705: Risk factors and Clinical Outcomes for Contrast Induced Nephropathy Post Percutaneous Coronary Intervention in Patients with Normal baseline Renal Function

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Eric Chong ◽  
Liang Shen ◽  
Yiong H Chan ◽  
Huay C Tan
Keyword(s):  
Diabetes Mellitus ◽  
Renal Function ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Clinical Predictors ◽  
Contrast Induced Nephropathy ◽  
Ventricular Ejection Fraction ◽  
Percutaneous Coronary ◽  
Baseline Renal Function

Background: Contrast induced nephropathy (CIN) is an important complication post percutaneous coronary intervention (PCI). We examine the risk factors for developing CIN in patients with normal baseline renal function so that prophylactic measures may be undertaken to prevent its development. Methods: A cohort of 5086 patients with normal baseline renal function (defined as serum creatinine <1.5mg/dl) who did not receive prophylactic treatment while undergoing PCI (primary or elective) between May 1996 to March 2007 in our centre was enrolled in the study. We examine the occurrence of CIN (defined as >25% increase from baseline creatinine within 48 hours post PCI) in 3036 subjects of this cohort with available creatinine data and aim to identify the clinical predictors. Results: CIN occurred in 7.3% of the patients. The mean age of these patients was 57.5 yrs, 78.7% were men, and 34.6% had diabetes mellitus. Clinical predictors for CIN were age (OR 6.4, 95% CI 0.1–13.3, p=0.042), female gender (OR 2.0, 95% CI 1.5–2.7, p=0.001), lower left ventricular ejection fraction (OR 1.02, 95% CI 1.01–1.04, p=0.01), anemia with hemoglobin <11mg/dl (OR 1.5 (95% CI 1.01–2.4, p=0.044) and systolic hypotension with blood pressure <100mmHg on admission(OR 1.5, 95% CI 1.01–2.2, p=0.004). While there was no increase in the incidence of CIN among diabetics and nondiabetics (8.2% vs 6.8%, p=0.18), those who are on insulin therapy are at the highest risk compared with diabetics on diet control and oral hypoglycemic drugs (18.9% vs 3.6% vs 6.8%, p=0.001). There was no significant difference between patients who underwent primary vs elective PCI (7.0% vs. 6.6% p=0.75). Patients who developed CIN had higher mortality rate at 1 month (14.5% vs 1.1%, p<0.001) and 6 month (17.8% vs 2.2%, p<0.001) Conclusion: Patients with normal baseline renal function undergoing PCI are also at risk of developing CIN with resultant higher mortality. Age, female, insulin dependent diabetes mellitus, hypotension, anemia, low left ventricular ejection fraction are predictors of CIN. Such patients should also be considered CIN prophylactic therapy.

scholarly journals Risk factors of contrast-induced nephropathy after percutaneous coronary intervention: a retrospective analysis

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110059
Author(s):  
Jing Wang ◽  
Chunyu Zhang ◽  
Zhina Liu ◽  
Yanping Bai
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Medical Information ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Contrast Induced Nephropathy ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective Contrast-induced nephropathy (CIN) is a serious complication in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). This study aimed to analyze the potential risk factors for CIN in patients undergoing PCI. Methods Patients with ACS who underwent PCI treatment from January 2017 to January 2020 were selected. The patients’ characteristics and medical information were collected and compared. Results A total of 1331 patients undergoing PCI were included. The incidence of CIN was 15.33%. Logistic regression analyses showed that a left ventricular ejection fraction ≤45% (odds ratio [OR] 4.18, 95% confidence interval [CI] 1.10–7.36), serum creatinine levels ≤60 μmol/L (OR 3.03, 95% CI 1.21–5.57), age ≥65 years (OR 2.75, 95% CI 1.32–4.60), log N-terminal pro-B-type natriuretic peptide levels ≥2.5 pg/mL (OR 2.31, 95% CI 1.18–5.13), uric acid levels ≥350 μmol/L (OR 2.29, 95% CI 1.04–5.30), emergency percutaneous intervention (OR 1.35, 95% CI 0.34–3.12), and triglyceride levels ≤1.30 mmol/L (OR 1.10, 95% CI 0.01–2.27) were independent risk factors for CIN in patients who underwent PCI. Conclusions Early prevention is required to reduce the occurrence of CIN in patients who undergo PCI and have risk factors for CIN.

P1964Impact of successful coronary intervention for chronic total occlusion on long-term clinical outcome of patients with impaired and preserved left ventricular ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Tanaka ◽  
T Tada ◽  
Y Fuku ◽  
T Goto ◽  
K Kadota
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Total Occlusion ◽  
Ventricular Ejection Fraction ◽  
Percutaneous Coronary ◽  
Procedural Success

Abstract Background Successful recanalisation of percutaneous coronary intervention for chronic total occlusion lesions has been associated with improved survival. Purpose This study aimed to assess the impact of successful percutaneous coronary intervention for chronic total occlusion lesions on the long-term outcome of patients with impaired and preserved left ventricular ejection fraction (LVEF). Methods The study sample consisted of 842 consecutive patients (928 chronic total occlusion lesions) undergoing percutaneous coronary intervention at our institution between October 2005 and December 2009. We divided them into 3 groups by the degree of LVEF: less than 40% (severely reduced LVEF, n=140), 40% to 59% (moderately reduced LVEF, n=470), and 60% and above (normal LVEF, n=232). We evaluated mortality during the 10-year follow-up period the basis of procedural success and failure. Results The overall procedural success rate was 89.1%. Median follow-up duration was 7.9 years. The 10-year cumulative incidences of cardiac death in each degree of LVEF are shown in the Figure. Conclusions Successful recanalisation for chronic total occlusion lesions in patients with impaired LVEF may be associated with reduced cardiac mortality.

scholarly journals Relationship between the ST-Segment Resolution and Microvascular Dysfunction in Patients Who Underwent Primary Percutaneous Coronary Intervention

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Byung Gyu Kim ◽  
Sung Woo Cho ◽  
Jeong-Ha Ha ◽  
Hyo Seung Ahn ◽  
Hye Young Lee ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Microvascular Dysfunction ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary

Objectives. Incomplete ST-segment elevation resolution (STR) occasionally occurs despite successful revascularization of epicardial coronary artery after primary percutaneous coronary intervention (PPCI). The aim of this study was to evaluate the relationship between the degree of STR and the severity of microvascular dysfunction. Methods. A total of 73 consecutive patients with ST-segment elevation myocardial infarction (STEMI) who underwent successful PPCI were evaluated. Serial 12-lead electrocardiography was performed at baseline and at 90 minutes after PPCI. Microvascular dysfunction was assessed by index of microvascular resistance (IMR) immediately after PPCI. Results. Patients were classified into 2 groups: 50 patients with complete STR (STR ≥50%) and 23 patients with incomplete STR (STR <50%). The incomplete STR group had a higher IMR value and lower left ventricular ejection fraction (LVEF), compared with the complete STR group. The degree of STR was significantly correlated with IMR (r = −0.416, P=0.002) and LVEF (r = 0.300, P=0.011). These correlations were only observed in patients with left anterior descending artery (LAD) infarction but not observed in patients with non-LAD infarction. A cutoff IMR value was 27.3 for predicting incomplete STR after PPCI. Conclusion. Incomplete STR after PPCI in patients with STEMI reflects the presence of microvascular and left ventricular dysfunction, especially in patients with LAD infarction.

P962Follow-up of protected high-risk percutaneous coronary intervention with microaxial Impella pump. Results from the retrospective German Impella Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Baumann ◽  
N Werner ◽  
F Al-Rashid ◽  
A Schaefer ◽  
T Bauer ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Primary Endpoint ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Percutaneous Coronary

Abstract Background Percutaneous coronary intervention (PCI) presents a relevant alternative to coronary bypass surgery for the treatment of patients with complex coronary artery disease and high perioperative risk. By temporary implantation of a percutaneous ventricular assist devices (pVAD) interventionalists attempt to anticipate the hemodynamic risk of those high-risk patients in a so-called protected PCI. The Impella® system presents the currently most common device for protected PCI and could show hemodynamic stability in earlier trials. Methods This study is a retrospective, observational multi-center registry of ten hospitals in Germany. We included patients undergoing protected high-risk PCI with Impella® support. The primary endpoint was defined as major adverse cardiac events (MACE) during a 180-day follow-up and consisted of all-cause mortality, myocardial infarction (MI) and stroke. Results Six of the participating hospitals performed a follow-up. In total, 157 patients (80.3% male; mean age 71.8±10.8 years) were included in the present study. Prior to PCI, median left ventricular ejection fraction was 39.0% (25.0%-50.0%) and median SYNTAX-Score I was 33.0 (24.0–40.5). The 180-day follow-up was available for 149 patients (94.9%). Eight patients (5.1%) were lost to follow-up. During the follow-up period, 34 patients (22.8%) suffered from a MACE. A total of 27 patients (18.1%) died. Nine patients (6.0%) sustained a MI, while 4 patients (2.7%) had a stroke. Kaplan-Meier curves for primary endpoint Conclusions Patients undergoing protected high-risk PCI with Impella® support show a good 180-day clinical outcome regarding rates of MACE and mortality. However, a head-to-head comparison of Impella supported patients to protected PCI with other pVADs is pending. Acknowledgement/Funding S.B., N.W., F.A.-R., J.-M.S., A.S., R.S., I.A. receive consulting fees/honoraria from Abiomed (Danvers, MA, USA).

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