Abstract 17042: Incidence and Predictors of Permanent Contrast Induced Nephropathy Among Patients Undergoing Diagnostic or Interventional Coronary Angiography
Background: Contrast induced nephropathy (CIN) is a common and problematic complication after coronary angiography. However, often times, the post-procedural drop in renal function is transient and the patient’s creatinine returns to baseline levels. The real concern is when the reduction in renal function is permanent. Although many studies have evaluated the incidence and predictors of CIN occurring shortly post-procedure, little information is known regarding the patients with permanent CIN (PCIN).
Methods: Baseline blood samples and clinical information were obtained from 7,429 consenting patients hospitalized for coronary angiography. Levels of serum creatinine were measured at baseline, up to 10 days post-catheterization and long-term (6-12 months post procedure), and change from baseline creatinine was calculated. CIN was defined as a ≥0.5 mg/dL rise or a 25% absolute increase in creatinine during the first 10 days and PCIN as a persistent ≥0.5 mg/dL rise by 6-12 months. Demographics, cardiac risk factors, and medical therapies were analyzed to determine independent predictors of PCIN. Logistic regression was used for the primary analysis.
Results: Average age was 65±13 yrs, 67% of pts were male and 42% underwent percutaneous coronary intervention. Overall, the incidence of CIN and PCIN were 15.1% and 3.5% respectively. Independent predictors of PCIN included diabetes (odds ratio (OR)=1.66, p<0.0001), diuretic use (OR=1.44, p=0.007), ACE inhibitor use (OR=0.72, p=0.03), warfarin use (OR=1.49, p=0.02) and baseline creatinine (by categories (mg/dL): 1.11-1.40 vs. <1.10, OR=1.54, p=0.02; 1.41-2.40 vs. <1.10, OR=1.75, p=0.003; >2.4 vs. <1.10, OR=10.83, p<0.0001; >2.4 vs. ≤2.4, OR=6.14, p<0.0001). Incidence of PCIN was 80/395(20.2%) vs. 181/6954(2.6%) for those with baseline creatinine >2.4 vs. ≤ 2.4 mg/dL.
Conclusions: Among patients undergoing coronary angiography, less than a quarter of those who experience CIN will go on to have PCIN. By far the strongest predictor of PCIN is serum creatinine >2.4 mg/dL. This creatinine threshold may assist decisions regarding proceeding with coronary angiography.
- © 2012 by American Heart Association, Inc.