Author + information
- Sergio Raposeiras Roubin,
- Emad Abu-Assi,
- Raymundo Ocaranza-Sanchez,
- Maria Castiñeira,
- Andrea Lopez,
- Noelia Bouzas,
- Jose-Maria García-Acuña and
- Jose Ramón González-Juanatey
The 2 most common non-thrombotic in-hospital complications in patients with Acute Coronary Syndorme (ACS) were contrast-induced nephropathy (CIN) and bleeding. The aim was to analyse the relationship between CIN and bleeding in a contemporaneous cohort of ACS patients, together with the predictive value of both for adverse in-hospital mortality.
A total of 940 consecutive patients with ACS were enrolled. CIN was defined based on an increase in serum creatinine ≥ 0.5 mg/dL within 72 hours of exposure. In-hospital bleeding presence and severity was recorded using TIMI scheme. Two binomial logistic regression models were used to evaluate the prognostic value of pre-catheterization bleeding to predict CIN and the independent value of the CIN to predict post-catheterization in-hospital bleeding.
54 patients presented CIN (5.7%) and 60 bleeding (6.4%; Major TIMI bleeding in 13 patients). Patients who had had bleeding previous to catheterization, or in relation with it, developed more CIN (30.0% vs 5.2%, p[[Unable to Display Character: ˂]]0.001). After multivariate adjustment, pre-catheterization bleeding was an independent predictor of the development of CIN [OR 5.41 (1.75–16.70), p=0.003], together with Mehran CIN score and troponin peak. The presence of CIN was also associated with a higher percentage of post-catheterization bleeding (18.5% vs 3.4%, p[[Unable to Display Character: ˂]]0.001). Adjusting by CRUSADE score, the development of CIN was found to be an independent predictor of post-catheterization bleeding [OR 3.03 (1.36–7.08), p=0.010]. After adjusting for the GRACE score, both variables (CIN and bleeding) resulted independent predictors of in-hospital death, increasing the power when both were combined [OR 15.99 (3.03–84.19), p=0.001].
Pre-catheterization bleeding was an independent predictor for the occurrence of CIN, and in a bilateral way, the development of CIN resulted an independent predictor for post-catheterization bleeding. In addition to this, CIN and bleeding increase the in-hospital death risk with independence of GRACE score, and the combination of both enhance this risk.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Bleeding and ACS: Predicting Risk and Measuring Impact
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1215M-198
- 2013 American College of Cardiology Foundation