Abstract 15132: Peripheral Endothelial Dysfunction is a Significant Determinant of Contrast-Induced Renal Damage in Patients Underwent Percutaneous Coronary Procedures
Background. Procedure-related and contrast-induced renal damage (PCRD) is an important complication of coronary angiography and percutaneous coronary interventions associated with poor cardiovascular outcomes. Risk factors for PCRD have been characterized and many of these factors overlap with coronary risk factors involving in endothelial dysfunction. We hypothesized that the peripheral endothelial dysfunction could correlate with the occurrence of PCRD.
Methods. We assessed endothelial function by measuring reactive hyperemia peripheral arterial tonometory index (RH-I) before the elective coronary procedures (coronary interventions: 34%) in 348 consecutive stable patients without established chronic kidney disease [estimated glomerular filtration rate >60 ml/min/1.73 m2]. We measured levels of serum creatinine (s-Cr) before and after the procedures (until 48 hours) to identify the occurrence of PCRD defined as any increase in s-Cr.
Result. Nearly half patients (n=165) developed PCRD and male gender, diabetes mellitus, and metabolic syndrome were significantly dominant in PCRD compared to non-PCRD (69% vs. 57%; 50% vs. 38%; 74% vs. 54%, respectively p<0.05). Patients with PCRD demonstrated significantly lower RH-I than non-PCRD patients (1.63 [1.44-1.84] vs. 1.80 [1.64-2.12], P<0.001). The percent changes of s-Cr showed significant negative correlation with Ln(RH-I) (r=-0.382, p<0.001), Ln(high-density lipoprotein cholesterol) (r=-0.166, p=0.002), and positive correlation with body mass index (r=0.185, p<0.01) and waist circumference (r=0.207, p<0.001). Multivariable logistic regression analysis including the previously identified risk factors for PCRD and coronary intervention revealed that RH-I [odds ratio (OR) 0.21, 95% confidence interval (CI) 0.09-0.45; p<0.001], plasma levels of B-type natriuretic peptide (BNP) (OR 1.01, 95% CI 1.00-1.02; p=0.01), and metabolic syndrome (OR 2.80, 95% CI 1.56-5.06; p<0.001) were independently associated with the occurrence of PCRD.
Conclusion. Presence of peripheral endothelial dysfunction is a significant determinant of the occurrence of PCRD. Assessment of endothelial function by PH-I could be useful for evaluating risk of PCRD and periprocedural patient care.
- © 2011 by American Heart Association, Inc.