Abstract 10939: Impact of Admission Hyperglycemia on the Development of Contrast-Induced Acute Kidney Injury in Patients with Acute Coronary Syndrome Undergoing Primary Percutaneous Coronary Intervention
Background: Patients with acute coronary syndrome (ACS) treated with primary percutaneous coronary intervention (PCI) are at increased risk of contrast-induced acute kidney injury (AKI), which is associated with prolonged hospitalization and adverse clinical outcome. In this study, we evaluated the impact of admission hyperglycemia for the development of contrast-induced AKI in 785 consecutive ACS patients (median age, 65 years; 691 males) undergoing primary PCI within 24 hours (median value, 6.0 hours) after admission. Contrast-induced AKI was defined as a 0.5 mg/dL or 25% increase in serum creatinine from the baseline value within 48 hours after the procedure. Of these patients, 68% had ST-segment elevation ACS, 28% had diabetes mellitus, 50% had hypertension, 32% had hyperlipidemia, 12% had a history of old myocardial infarction, and 47% had multi-vessel disease.
Results: The median glucose level at admission was 153 mg/dL (25th to 75th percentile, 120 to 211 mg/dL). Contrast-induced AKI occurred in 242 (31%) patients. The incidence of contrast-induced AKI significantly increased with each quartile of glucose at admission (1st, 9.5%; 2nd, 21.1%; 3rd, 39.5%; and 4th, 54.2%, P < 0.0001). Clinical characteristics and cardiac mortality rate during a median follow-up period of 744 days in patients with and without contrast-induced AKI were shown in Table. Stepwise logistic analysis, including 13 clinical and angiographic variables, revealed that hyperglycemia at admission was independently associated with contrast-induced AKI in all patients (odds ratio, 1.09 per 10 mg/dL increase, P < 0.0001), the subgroup of diabetic patients (1.10 per 10 mg/dL increase, P = 0.0001), and the subgroup of non-diabetic patients (1.10 per 10 mg/dL increase; P < 0.0001).
Conclusion: Admission hyperglycemia may be a potent independent risk factor for the development of contrast-induced AKI in patients both with and without diabetes mellitus.
- © 2010 by American Heart Association, Inc.