Abstract 2018: Comparison of Risks and Clinical Predictors of Contrast Induced Nephropathy in Patients Undergoing Primary versus Elective Percutaneous Coronary Intervention
Background: Contrast nephropathy (CIN) post percutaneous coronary intervention (PCI) increases adverse clinical outcomes. We examine and compare the risks and clinical predictors of CIN among patients who undergo primary versus elective PCI and the effectiveness of prophylactic treatments.
Methods: A cohort of 8798 patients who underwent PCI from May 1996 to April 2008 were enrolled. We divided patients into 3 groups(Grp). A: STEMI patient undergoing primary PCI. B: NSTEMI patients undergoing early elective PCI. C: stable patients without myocardial infarction(MI) undergoing elective PCI. Prophylactic saline hydration and oral N-acetylcysteine (NAC) treatment were given to Grp B and C if they have baseline renal impairment (glomerular filtration rate, GFR ≤60ml/min/1.73m2). Grp A patients were unable to receive pre-PCI prophylaxis due to emergency situation. The occurrence of CIN and mortality were compared among 3 grps.
Results: Mean age was 57.4±11.1 years. 3146(35.9%) were diabetics. CIN occurred in 12.0% vs. 9.2% vs. 4.5% p=<0.0005, in Grp A, B, C respectively. CIN correlated with increased mortality (15.5% vs. 1.3% p<0.0005) at 1 month. Significant risk predictors of CIN are shown in table
Incidence of CIN categorized according baseline renal function based on GFR range are shown in table
Clinical predictors of CIN Incidence of CIN categorized by different GFR subgroups
Conclusion: Saline and NAC prophylaxis are effective in preventing CIN in milder renal impaired patients (GFR 40 – 60) but are less effective in the more severely renal impaired patients (GFR<40). Patients presenting with STEMI undergoing primary PCI are at the highest risk for development of CIN. Accelerated prophylactic therapy need to be developed to reduce CIN in this cohort.