Abstract 10726: Elevated Fasting Glucose is an Important Risk Factor for Contrast-Induced Nephropathy in Non-Diabetic Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Introduction: In non-diabetic patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI), fasting glucose the day after admission (FG) is a better predictor of early mortality than admission glucose (AG). Recent studies reported that elevated AG is a risk factor for contrast-induced nephropathy (CIN). However, little is known regarding the association between FG and CIN. We assessed the hypothesis that elevated FG is associated with increased risk for CIN in non-diabetic patients with AMI undergoing primary PCI.
Methods: From July 2008 to March 2012, a total of 192 consecutive non-diabetic patients (viz. those who did not have a previous diagnosis of diabetes) with AMI undergoing primary PCI were enrolled in this study. CIN was defined as maximum percentage increases in serum creatinine from baseline within 72 hours of catheterization (Max%sCr) ≥ 25%. According to FG, patients were divided into the 4 groups; normal FG (n = 43, FG < 100mg/dl) and tertiles of elevated FG (first tertile, n = 50, FG 100 - 113mg/dl; second tertile, n = 50, FG 114 - 128mg/dl; third tertile, n = 49, FG ≥ 129mg/dl). Between the 4 groups, Max%sCr were compared. The association between Max%sCr and admission hyperglycemia (AH; AG ≥ 200mg/dl) or fasting hyperglycemia the day after admission (FH; FG ≥ 126mg/dl) were also evaluated.
Results: Between the 4 groups, there were no significant differences in contrast dose. Overall, FG had a significant simple correlation with Max%sCr (r = 0.364, p < 0.001). Third tertile of elevated FG had a greater Max%sCr than normal FG and first tertile (median, 16.0% [Q1 - Q3, 1.19% - 29.8%] vs. 3.13% [-3.68% - 14.6%], and 2.65% [-6.24% - 9.68%]; Steel-Dwass test, p=0.031 and 0.008 respectively). The adjusted odds ratio for CIN was 6.55 (95%CI, 1.11 - 38.7; p = 0.038) in third tertile of elevated FG compared with normal FG. Furthermore, patients with both AH and FH (n = 21) had a greater Max%sCr than those with only AH (n = 14) and those without both AH and FH (n = 117) (17.1% [5.77% - 28.0%] vs. -2.30% [-14.9% - 4.08%], and 4.21% [-4.11% - 15.9%]; Steel-Dwass test, p = 0.001 and 0.022 respectively).
Conclusion: Elevated FG is significantly associated with increased risk for CIN in non-diabetic patients with AMI undergoing primary PCI.
- © 2012 by American Heart Association, Inc.