Assessment of Acute Kidney Injury in Patients Undergoing Elective Coronary Angiography and Percutaneous Coronary Intervention

2012 ◽  
Vol 5 (1) ◽  
pp. 37-43
Author(s):  
ABMM Alam ◽  
M Moniruzzaman ◽  
MB Alam ◽  
N Islam ◽  
F Khatoon ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Contrast Media ◽  
Creatinine Level ◽  
Ace Inhibitor ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Group I ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Group Ii

Background: CIN has gained increased attention in the clinical setting, particularly during cardiac intervention but also in many other radiological procedures in which iodinated contrast media are used. There is at present good clinical evidence from well-controlled randomized studies that CIN is a common cause of acute renal dysfunction.Methodology: This was a prospective study conducted among the patients who underwent coronary angiography and percutaneous coronary intervention in the Department of Cardiology, Dhaka Medical College Hospital during January 2010 to December 2010. A total of 111 patients age range from 25 to 75 years were included in the study. Serum creatinine level at baseline and at the end of 48 hours was done in all these patients. Study population was divided into two groups according to development of acute kidney injury (AKI). Group-I = AKI, Group II = Not developed AKI. Results: AKI developed 11.7% of the study patient. DM and Preexisting renal insufficiency were significantly higher in group I patients. HTN was (61.5% Vs 44.9%) higher in group I but not significantly. History of ACE inhibitor/ARB, NSAID intake and LVEF <40% were significantly higher in group I patients. The mean±SD volume of CM (Contrast Media) were 156.9±44.8 ml and 115.4±30.0 ml in group I and group II respectively, which was significant. The mean±SD of serum creatinine after 48-72 hours of CAG/PCI was 1.4±0.37 mg/dl and 1.1±0.2 mg/dl in group I and group II respectively. The serum creatinine level increased significantly (p<0.05) after 48-72 hours of CAG/PCI in group I. In group II, S. creatinine level increased but not significant (p>0.05). Impaired renal function was found 76.9% and 2.0% in group I and group II respectively. DM, HTN, preexisting renal insufficiency, ACE inhibitor/ARB, NSAIDs, contrast volume (>150 ml), eGFR (<60 ml/min/ 1.73m2) and LVEF (<40%) are significantly (p0.05) associated for CIN development.Conclusion: CIN is an iatrogenic but preventable disorder results from the administration of contract media. Although rare in the general population, CIN occurs frequently in patients with underlying renal dysfunction and diabetes. In patients with pre angiographic normal renal function, the prevalence is low but in pre-existing renal impairment it may pose a serious threat. Thus risk factors are synergistic in their ability to predispose to the development of CIN. A careful risk-benefit analysis must always be performed prior to the administration of contrast media to patients at risk for CIN. DOI: http://dx.doi.org/10.3329/cardio.v5i1.12227 Cardiovasc. j. 2012; 5(1): 37-43

Neutrophil gelatinase associated lipocalin, an early biomarker for diagnosis of acute kidney injury after percutaneous coronary intervention

2017 ◽  
Vol 43 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Nakhshab Choudhry ◽  
Amna Ihsan ◽  
Sadia Mahmood ◽  
Fahim Ul Haq ◽  
Aamir Jamal Gondal
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Diagnostic Biomarker ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
The Mean

AbstractObjectives:This study was designed to find the reliability of serum NGAL as an early and better diagnostic biomarker than that of serum creatinine for acute kidney injury after percutaneous coronary intervention in Pakistani population.Materials and methods:One hundred and fifty-one patients undergoing elective percutaneous coronary intervention were included and demographic data were recorded. Blood was drawn by venipuncture in clot activator vacutainers and serum was separated and stored at 4°C. Sample was drawn before the percutaneous procedure and subsequently sampling was done serially for 5 days.Results:The mean±SD serum NGAL pre-PCI (39.92± 10.35 μg/L) and 4 h post-PCI (100.42±26.07 μg/L) showed highly significant difference (p<0.001). The mean±SD serum creatinine pre-PCI (70.1±11.8 μmol/L) and post-PCI (71.2±11.6 μmol/L) showed significant difference (p=0.005) on day 2 onwards but mean microalbumin showed insignificant results (p=0.533). The serum NGAL predicted CI-AKI with sensitivity of 95.8% and specificity of 97.6% for a cut off value of 118 μg/L.Conclusion:Our results suggest that NGAL is an excellent early diagnostic biomarker for acute kidney injury in patients undergoing elective percutaneous coronary intervention.

scholarly journals MON-241 THE CHANGES OF SERUM CREATININE AFTER CONTRAST MEDIA EXPOSURE IN PERCUTANEOUS CORONARY INTERVENTION

2019 ◽  
Vol 4 (7) ◽  
pp. S399
Author(s):  
N. Paramita Ayu ◽  
G. Widiana Raka ◽  
W. Sudana ◽  
K. Suwitra ◽  
J. Loekman Sidharta ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Serum Creatinine ◽  
Contrast Media ◽  
Media Exposure ◽  
Coronary Intervention ◽  
Percutaneous Coronary

scholarly journals Comparison of In-Hospital Outcomes of ST Elevation Myocardial Infarction in Patients Undergoing Transradial and Transfemoral Primary Percutaneous Coronary Intervention

2019 ◽  
Vol 11 (2) ◽  
pp. 98-104
Author(s):  
Fahdia Afroz ◽  
Mir Jamal Uddin ◽  
Md Khalquzzaman ◽  
Mohammad Ullah ◽  
Mohammad Khalilur Rahman Siddiqui ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Group I ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Group Ii

Background: Primary percutaneous coronary intervention (PPCI) has been performed traditionally by using femoral approach. Transradial approach has become increasingly popular as it is likely to be less complicating, more comfortable and relatively cost effective having mortality and morbidity benefits. The aim of the study was to compare the in-hospital outcomes of transradial PPCI with that of transfemoral route. Methods: A total of 80 patients with ST elevation myocardial infarction (STEMI) who underwent PPCI were enrolled in the study. Patients were divided in two groups. Group-I: transradial PPCI; and Group-II: transfemoral PPCI. All patients were followed up during the period of hospital stay and adverse outcomes were observed and compared between the groups. Results: The result showed that bleeding took place in 2.5% patient of Group-I and 15% patients of Group- II. Vascular complications occurred in 2.5% and 12.5% patients of Group-I and Group-II, respectively. In Group-II, 7.5% patients died with none in Group-I. In Group-II, 37.5% patients experienced some sort of adverse outcomes whereas only 15% of the patients of Group-I did have such experiences (p<0.05). Bleeding and vascular complications were significantly more in Group-II (p<0.05). The mean hospital stay time was significantly lower in Group-I (p<0.001). Conclusions: Transradial PPCI is safer than transfemoral approach in respect of procedural and post procedural complications including bleeding, vascular complications and mortality. So, transradial approach may be an attractive alternative to conventional transfemoral approach and can be practiced routinely for PPCI. Cardiovasc. j. 2019; 11(2): 98-104

scholarly journals Editor’s Choice- What do small serum creatinine changes tell us about outcomes after acute myocardial infarction?

2017 ◽  
Vol 7 (8) ◽  
pp. 739-742 ◽  
Author(s):  
Johann Auer ◽  
Frederik H Verbrugge ◽  
Gudrun Lamm
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Percutaneous Coronary

Acute kidney injury (AKI), mostly defined as a rise in serum creatinine concentration of more than 0.5 mg/dl, is a common, serious, and potentially preventable complication of percutaneous coronary intervention and is associated with adverse outcomes including an increased risk of inhospital mortality. Recent data from the National Cardiovascular Data Registry/Cath-PCI registry including 985,737 consecutive patients undergoing percutaneous coronary intervention suggest that approximately 7% experienced AKI with a reported incidence of 3–19%. In patients undergoing primary percutaneous coronary intervention for acute myocardial infarction (AMI), AKI occurs more frequently with rates up to 20% depending on patient and procedural characteristics. However, varying definitions of AKI limit comparisons of AKI rates across different studies. Recently, most studies have adopted the Acute Kidney Injury Network (AKIN) criteria for definition and classification of AKI. Beyond the AKIN criteria for AKI, other classifications such as the risk, injury, failure, loss and end-stage kidney disease (RIFLE) and kidney disease: improving global outcomes (KDIGO) criteria are used to define AKI. Notably, even small increases in serum creatinine beyond AKI may be associated with adverse outcomes including increased hospital length of stay and excess. Acute kidney injury (AKI) is a serious and potentially preventable complication of percutaneous coronary intervention (PCI). Worsening renal function is associated with adverse outcomes including a higher rate of in-hospital mortality. In patients undergoing primary PCI for acute myocardial infarction (AMI), AKI occurs up to 20% of such individuals. Varying definitions of AKI limit comparisons of AKI rates across different studies. Additionally, even small increases in serum creatinine beyond lavels meeting AKI definitions may be associated with adverse outcomes including increased hospital length of stay.

scholarly journals Hospital outcome of percutaneous coronary stenting in long segment lesions

2021 ◽  
Author(s):  
M. Bashir Uddin ◽  
A. B. Siddique ◽  
M. Shirajum Munir ◽  
Refaz Uddin ◽  
Abdullah Al Masud ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Coronary Intervention ◽  
Coronary Stenting ◽  
Great Success ◽  
Common Procedure ◽  
St Depression ◽  
Group I ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Group Ii

Background: Coronary heart disease is increasing at an alarming rate among elder people in Bangladesh. For long segment lesion in heart, percutaneous coronary intervention is now a common procedure with great success rate.  The aim of this study was to assess immediate outcome of percutaneous coronary stenting of long segment lesions.Methods: This prospective observational study was conducted at the Department of cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh during the period from January 2005 to December 2006. The sample size was 100 patients undergoing PCI of long and short coronary lesions.Results: No complications found in 82.0% and 88.0% of cases in group I and II respectively. Coronary dissection occurred in 6% and 4% cases in group I and II respectively. ST elevation and pathological Q were 46.0% in pre and 50.0% in post PCI period in group I. In group II patients 48.0% in pre and 52.0% in post PCI period showed ST elevation and pathological Q wave. ST depression and/or T inversion was 18.0% in pre and 16.0% in post PCI period in group I, in group II this value was 22.0% and 14.0% respectively. In group I patients, CK-MB increased from 24.33±7.72 U/l in baseline to 43.30±10.99 U/l 6-8 hrs after procedure and before discharge CK-MB decreased to 31.91±11.17 U/l. In the group II patients, it increased from 25.42±5.84 U/l in baseline to 39.38±6.98 U/l 6-8 hrs after procedure and before discharge CK-MB decreased to 29.64±8.21 U/l.Conclusions: This study concludes that the immediate outcome of long segment coronary stenting is safe and highly effective.

scholarly journals Pre-Procedural C-Reactive Protein Level Predicts In-Hospital Outcome in Percutaneous Coronary Intervention

1970 ◽  
Vol 4 (1) ◽  
pp. 32-41 ◽  
Author(s):  
MM Haque ◽  
M Ullah ◽  
MS Alam ◽  
SU Ulabbi ◽  
R Uddin
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Spasm ◽  
Coronary Intervention ◽  
Side Branch ◽  
Major Adverse Cardiovascular Events ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Group I ◽  
Percutaneous Coronary ◽  
Group Ii

Background:To accurately stratify patients undergoing PCI, according to their risk of future adverse events, a quest for risk predictors is ongoing worldwide. But only a few powerful and independent predictors of early and late major adverse cardiovascular events have been found. These include traditional risk factors, such as acute coronary instability, diabetes mellitus, reference vessel diameter, and lesion and/or stent length. This study was undertaken to find out the relationship between pre-procedural CRP level with in-hospital (both procedural and before discharge) complications. Materials & methods: This prospective study was carried out in National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period of June,2006 to May,2007. After fulfilling the exclusion criteria, 100 consecutive patients were selected as sample those underwent percutaneous coronary intervention. C-Reactive protein (CRP) was measured in all patients before the procedure. Those having pre-procedural CRP level <.3 mg/dl was labeled as group-I and those with CRP level e”.3 mg/dl was labeled as group-II. In hospital outcomes were compared between two groups after percutaneous coronary intervention. Results: During the procedure, higher rate of complications (10.0% vs 26.0%) were noted in group- II, which was statistically significant. Among many complications abrupt occlusion, threatened (dissection and new thrombus) and residual stenosis were significantly high in group-II. Other complications like coronary spasm, arrhythmia, side branch occlusion, heart failure, shock and no reflow were also high in higher level of CRP level patients but statistically not significant. Inhospital complications were also significantly high (10.0% vs 28.0%) in patients with higher level of CRP ie. Group-II. Among other complications recurrence of ischemia and myocardial infarction developed at significantly higher rate in group-II. Post procedural CK-MB rose significantly (18.0% vs 36.0%) in patients with higher level of CRP (group-II) in comparison to normal level of CRP patients (group-I). When the in-hospital complications were distributed among three tertiles of CRP, it was observed that complications were proportionately high with increasing level of CRP. Conclusions: Many studies, conducted abroad, have suggested that factors like gender, extreme age, diabetes, multi-vessel disease and lesion characteristics adversely influence PCI outcome. But in this study, multivariate regression analysis has shown that elevated level of CRP is even stronger independent predictor of PCI outcome. Keywords: C-Reactive Protein; In hosital outcome; PCI. DOI: http://dx.doi.org/10.3329/cardio.v4i1.9387 Cardiovasc. J. 2011; 4(1): 32-41

Temporal trends of acute kidney injury in patients undergoing percutaneous coronary intervention over a span of 12 years

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Skalsky ◽  
T Bental ◽  
H Vaknin-Assa ◽  
A Assali ◽  
G Greenberg ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Serum Creatinine ◽  
Temporal Trends ◽  
Early Period ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Late Period ◽  
Percutaneous Coronary ◽  
Over Time

Abstract Background Acute kidney injury (AKI) is a known complication following percutaneous coronary intervention (PCI), and is associated with higher rates of complications. We sought to determine the potential impact of temporal changes on the rates of AKI over time, as well as possible determinants of risk. Methods From a large prospective registry of patients undergoing PCI, 20,032 consecutive patients were assessed at two time periods: 2006–2012 and 2012–2018. Of these, included were cases for which data existed regarding change in creatinine levels from baseline to 48 hours after PCI. AKI was defined according to two methods- a relative elevation of ≥25% in serum creatinine or an absolute elevation of ≥0.5 mg/dL in serum creatinine at 48 hours. Results 15,153 patients were available for final analysis, 7,913 in the first period and 7,240 in the second. Mean age was 65.0y and 66.0y (p&lt;0.01) and baseline creatinine was 1.08 mg/dL and 1.15 mg/dL respectively (p&lt;0.01, table 1). AKI according to 25% relative rise in serum creatinine was documented in 11.1% in the early period and in 7.3% of the patients in the late period, p&lt;0.01. According to the definition of 0.5 mg/dL absolute rise in serum creatinine, respective rates were 3% and 2.9%, p=0.82 (figure 1). Multivariate analysis demonstrated a lower risk of AKI in the late period (OR- 0.72; CI 0.61–0.85, P&lt;0.01). Factors associated with risk of AKI included reduced ejection fraction (OR-0.98; CI 0.976–0.99, p&lt;0.01), older age (OR-1.01; CI 1.005–1.02, p=0.01) and female gender (OR- 1.73; CI 1.46–2.06, p&lt;0.01). Conclusions We have witnessed an improvement in the rates of post-PCI AKI over time. Further research is warranted, to further reduce peri-procedural AKI. Figure 1. Change in the rates of AKI Funding Acknowledgement Type of funding source: None

P5532Predictive value of objective nutritional scores for contrast-induced acute kidney injury in elderly patients undergoing percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Lin ◽  
L Chen ◽  
L Chen ◽  
C Han ◽  
C Han ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
Percutaneous Coronary ◽  
Conut Score

Abstract Background Age >75 years had been generally considered to be an important and independent risk factor of contrast-induced acute kidney injury (CI-AKI), while these patients often suffer from malnutrition. However, the predictive value of objective nutritional status for CI-AKI in elderly patients undergoing percutaneous coronary intervention (PCI) remains unknown. Purpose To evaluate the association of two kinds of objective nutritional indices includes controlling nutritional (CONUT) score and prognostic nutritional index (PNI) with CI-AKI in elderly patients undergoing PCI. Methods In a single center prospective cohort study,we enrolled 714 consecutive patients who aged >75 years undergoing PCI between January 2012 and December 2015 were screened based on their serum albumin, lymphocyte count, and total cholesterol measures. Patients were stratified into different groups according to two kinds of objective nutritional scores. Patients were divided into low-PNI (PNI <35), middle-PNI (35 ≤ PNI <38), and high-PNI (PNI ≥38). They were also divided into four groups according to CONUT score: normal-CONUT (0–1), mild-CONUT (2–4), moderate-CONUT (5–8), and severe-CONUT (≥9). CI-AKI was defined as an increase in the serum creatinine levels of ≥50% or 0.3 mg/dL above the baseline level within 48hrs after contrast medium exposure. Results Overall, 55 (7.7%) had moderate-severe CONUT scores, and 35 (4.9%) had low-middle PNI scores,while 93 (13.0%) patients developed CI-AKI. Patients with a lower PNI score or higher CONUT score had significantly higer incidence of CI-AKI [PNI score: high (11.8%), middle (33.3%), and low (45.5%), respectively; P<0.0001; CONUT score: normal (9.6%), mild (12.7%), moderate (30.2%), and severe (100%), respectively; P<0.0001]. After adjusting 6 confounders, including age, serum creatinine (SCR) >1.5mg/dl, left ventricular ejection fraction (LEVF) <45%, myocardial infarction, peri-hypotension and the contrast volume >200 ml, multivariate analysis showed that worse objective nutritional status (either lower PNI scores or higer CONUT scores) was associated with an increased CI-AKI risk (Low PNI vs High PNI: OR: 5.274, P=0.015; Moderate-Severe CONUT vs Normal CONUT: OR: 2.891, P=0.007). Incidence of CIAKI Conclusions Worse objective nutritional status was associated with CI-AKI in elderly patients after PCI.

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