Abstract 11080: The Definition Utilized Influences the Rates and Predictors of Contrast-Induced Nephropathy After Emergency Coronary Angiography For Acute Myocardial Infarction
Contrast-induced nephropathy (CIN) is associated with adverse outcomes after emergency coronary angiography or percutaneous coronary intervention for acute myocardial infarction (AMI). Although several CIN definitions have been used, whether the definition influences the rates and predictors of CIN remain unclear. We studied 733 patients with AMI undergoing emergency coronary angiography or percutaneous coronary intervention within 12 h after the onset. We used 3 definitions to identify the CIN; serum creatinine (SCr) increase ≥0.5 mg/dl, SCr increase ≥25%, or estimated glomerular filtration rate (eGFR) decrease ≥25% within 3 days after the admission. For each definition, multivariate analysis was used to recognize clinical predictors of CIN among the variables associated (p<0.05) with this diagnosis on univariate analysis. Of 733 patients (age 64±12 years), 27% were diabetic, 47% were anterior AMI, 9% had renal dysfunction defined as admission SCr ≥ 1.2 mg/dl, and 81% underwent primary percutaneous coronary intervention. The use of contrast volume was 155±57 ml. The rates of CIN were 7.8% (SCr increase ≥0.5 mg/dl), 37.4% (SCr increase ≥ 25%), and 29.2% (eGFR decrease ≥ 25%), respectively. Multivariate variables associated with CIN differed by the definitions, but both anterior AMI and time to admission ≥2 h were associated with CIN in all 3 definitions (Table). In patients with anterior AMI who were admitted ≥2 h from the onset, the rates of CIN were 19% (SCr increase ≥0.5 mg/dl), 61% (SCr increase ≥ 25%), and 48% (eGFR decrease ≥ 25%), respectively. In conclusion, the rates of CIN vary widely and the predictors of CIN differ depending on the definition used in patients with AMI undergoing emergency coronary angiography or percutaneous coronary intervention. These findings suggest the need for a standardized CIN definition, but anterior AMI patients with delayed presentation are in increased risk of CIN, irrespective of the definition.
- © 2010 by American Heart Association, Inc.