Abstract 15734: Contrast Induced Nephropathy after Primary PCI for STEMI: usefulness of a new definition
BACKGROUND: Renal impairment and contrast-induced nephropathy (CIN) have been shown to have an impact on outcome in STEMI patients.
OBJECTIVES: The aim of this study was to assess the prevalence and impact on outcome of CIN occurring after primary PCI (pPCI) for STEMI
METHODS: In 924 consecutive STEMI patients undergoing pPCI, we measured serum creatinine concentration (CrC) and calculated clearance (CrCl) at admission and each day during hospitalization. Renal impairment was defined as a CrCl<60ml/min. CIN was defined #1- by an increase of 25% of Cr C between the baseline and the peak and, # 2- by a decrease of 25% of CrCl according to the Cockroft-Gault Formula.
RESULTS: Renal impairment was found in 26.1% at admission and in 29.6% of patients after the pPCI and had a major impact on in-hospital mortality (13.8% vs. 2.25% in patients without renal dysfunction, OR 7.1 (3.7-13.7); p<0.0001). The relation was even stronger after pPCI (15.6% vs. 1.7%, OR 8.8 (3.9-19.8); p<0.0001). Using def #1, CIN occurred in 17.2% (159) of patients and was associated with a three-fold increase in mortality when compared with patients without CIN (11.6% vs. 3.9%, OR 3.2 (1.6-66), p=0.0036). The rate of CIN was 11.3% (104) with def #2 and associated with a four-fold increase in mortality (15.3% vs. 4.0%, OR 4.3 (2.0-9.3), p=0.0005). The combined effect on in-hospital mortality of baseline renal impairment and CIN after pPCI is shown on figure 1. The mean volume of contrast media was similar in patients developing CIN or not (218±44 vs. 217±50; p=0.8 with def #1; 213±39 vs. 218±49; p =0.5 with def #2). Contrast media volume did not relate to survival either (219± 9 ml vs. 216± 2 ml; p=0.7).
CONCLUSIONS: In STEMI patients undergoing pPCI, CIN is a major factor of mortality when it occurs in patients with basal renal impairment. The new definition of CIN based on CrCl seems more sensitive than the classic one based on CrC.
- © 2011 by American Heart Association, Inc.