Abstract 13863: Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker Administration following Cardiac Catheterization Reduces Contrast-Induced Nephropathy
Background: Contrast-induced nephropathy (CIN) is a complication of cardiac catheterization. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are often prescribed in those undergoing cardiac catheterization. Studies evaluating ACEI/ARB use and cardiac catheterization to date have produced mixed results on these medications effect on CIN.
Methods: 5,339 patients in Intermountain Heart Collaborative Study (Salt Lake City, UT) undergoing cardiac catheterization with one year of follow-up were studied for ACEI/ARB use documented at the time of discharge. Multivariable logistic regression, adjusted by CVD risk factors, baseline creatinine, contrast amount, medications, and CAD status evaluated for the occurrence of CIN (increase in creatinine of 25% or 0.5 mg/dL within 10 days of contrast). Secondary outcomes at 1 year included creatinine increase and all-cause mortality.
Results: ACEI/ARB recipients (2,706 [51%]) had more CAD risk factors: they were more likely to be male (67.5% vs 64.2%, p=0.01), have hypertension (68.8% vs 58.1%, p<0.0001), dyslipidemia (62.5% vs 54.9%, p<0.0001), diabetes (31.0% vs 26.2%, p<0.0001), family history of CAD (37.6% vs 33.2%, p=0.001), prior MI (17.5% vs 14.5%, p=0.002), prior CAD (62.2% vs 57.1%, p<0.0001), undergone PCI (52.8% vs 30.7%, p<0.0001), and receive more contrast (167.3 mL vs 129.7 mL, p<0.0001). Despite this, fewer ACEI/ARB recipients developed CIN: 330/2706 (12.2%) vs 489/2633 (18.6%) in non-recipients (adjusted OR=0.71, 95% CI=0.60-0.83, p<0.0001). Non-recipients had higher creatinine at baseline (1.37 mg/dL vs 1.22 mg/dL, p<0.0001) and at 1 year (1.45 mg/dL vs 1.33 mg/dL, p<0.0001). Creatinine increased 0.10 mg/dL in the ACEI/ARBs group and 0.08 mg/dL in non-recipients (p=0.13). 1 year mortality was 3.5% in ACEI/ARB recipients vs 4.1% in non-recipients (p=0.21).
Conclusions: We demonstrate that use of ACEI/ARBs following cardiac catheterization was associated with lower CIN risk even after adjustment for cardiovascular risk factors and baseline creatinine. There were no differences in creatinine change and mortality at 1 year. Further research is required to better characterize the role and timing of ACEI/ARB use with cardiac catheterization.
- © 2013 by American Heart Association, Inc.