Abstract 11748: Pre-Procedural Glucose Levels and the Risk for Contrast-Induced Acute Kidney Injury in Patients Undergoing Emergency Coronary Intervention Whose Contrast Volume Was Below Maximum Allowable Contrast Dose
Background: Contrast-induced acute kidney injury (CI-AKI) remains an adverse outcome for patients even when contrast volume does not exceed the maximum allowable contrast dose (MACD). Furthermore, MACD is not exceeded in approximately 80% of the patients undergoing percutaneous coronary intervention (PCI). Thus, we prospectively investigated the incidence, risk factors and outcome of CI-AKI in patients with acute coronary syndrome (ACS) undergoing emergency PCI whose contrast volume was below MACD.
Methods: Seven hundred thirty consecutive patients with ACS undergoing emergency PCI with contrast volume less than MACD were enrolled in this study. MACD was defined as (5 ml × body weight [kg]/baseline serum creatinine level [mg/dl]). CI-AKI was defined as a greater than 25% increase in serum creatinine level from the baseline or an absolute increase of ≥0.5 mg/dl within 48 hours after the procedure.
Results: CI-AKI occurred in 212 (29%) patients. Patients who developed CI-AKI had a higher risk for in-hospital mortality (9.4% vs. 1.5%, P < 0.0001) and a longer stay in the coronary care unit (median, 4.0 vs. 3.0 days, P = 0.0002) compared with those who did not. In a multivariate logistic analysis including 18 clinical variables, elevated glucose levels as variables categorized into quartiles were independently (P < 0.0001) associated with the development of CI-AKI. In addition, this relationship was seen in both the subgroup of patients with known diabetes (n = 197) and that of those without known diabetes (n = 533). The incidence of CI-AKI according to quartiles of glucose levels in all patients, patients with and without known diabetes is shown in Figure.
Conclusion: CI-AKI may occur commonly and may be associated with a more complicated clinical course in patients with ACS undergoing emergency PCI whose contrast volume does not exceed MACD. Elevated pre-procedural glucose levels may be a powerful and independent risk factor for the development of CI-AKI in this population.
- © 2011 by American Heart Association, Inc.