Abstract 11578: Impact of the Contrast-Induced Nephropathy Definition on Long-term Outcome in Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Introduction: Contrast-induced nephropathy (CIN) has been shown to be associated with adverse outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Although several CIN definitions have been used, there is no consensus on the optimal definition of CIN. Hypothesis: Long-term mortality and major adverse cardiac and cerebrovascular event (MACCE) may differ depending on the CIN definition used in patients with AMI undergoing primary PCI.
Methods: We measured serum creatinine on admission and for the following 3 days in 583 patients (age 64 ± 12 years, male 79%) with AMI undergoing PCI within 12 h after symptom onset. CIN was defined as serum creatinine increase >0.5 mg/dl, serum creatinine increase >25%, or estimated glomerular filtration rate (eGFR) decrease >25%.
Results: The mean volume of contrast medium was 167 ± 53 ml. The incidence of CIN widely ranged depending on the definition used; 7.8% (serum creatinine increase ≥0.5 mg/dl), 37.0% (serum creatinine increase ≥ 25%), and 29.5% (eGFR decrease ≥ 25%). CIN defined as serum creatinine increase ≥0.5 mg/dl was significantly associated with 5-year mortality and MACCE (all-cause death, non-fatal myocardial infarction, or stroke) in univariate and multivariate analysis, but CIN by the other 2 definitions was not. (Table)
Conclusions: In patients with AMI undergoing primary PCI, among the 3 contemporary definitions of CIN, only serum creatinine increase ≥0.5 mg/dl strongly predicts 5-year adverse outcomes, suggesting the prognostic importance of this definition.
- © 2012 by American Heart Association, Inc.