Author + information
- Per Thayssen,
- Jens F. Lassen,
- Svend Eggert Jensen,
- Knud Noerregaard Hansen,
- Henrik Steen Hansen,
- Evald H. Christiansen,
- Anders Junker,
- Jan Ravkilde,
- Leif Thuesen,
- Karsten T. Veien and
- Lisette Okkels Jensen
In patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), contrast–induced nephropathy (CIN) is a serious condition, which may be associated with prolonged hospitalization and adverse clinical outcome. We compared the risk of CIN in patients with and without renal insufficiency (RI) treated with preventive strategies.
Of 720 patients randomized in the “Prevention of Contrast–induced Nephropathy in Patients With ST–Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention” trial, serum–creatinine (S–Cr) levels at day 2–3 were available in 644 patients (93%). Patients were randomly assigned in a 1:1:1:1 ratio to receive hydration with sodium chloride (NaCl) together with 1 of 4 prophylactic regimes (1) N–acetylcysteine, (2) sodium bicarbonate infusion, (3) N–acetylcysteine in combination with sodium bicarbonate, or (4) hydration with NaCl infusion. Patients with cardiogenic shock were excluded. The primary end point was the development of acute CIN, defined as an increase in S–Cr concentration >25% from the baseline value within the 3–day period after primary PCI. Estimated creatinine clearance (CrCl) was calculated as: 186 × S–Cr–1.154 × age– 0.203 × 0.742 [if female]. A CrCl of ≤60 mL/min was chosen to define RI.
RI at baseline was present in 8.1% of patients. Overall, CIN occurred in 141 (21.9%) patients. Of the 53 patients with baseline CrCl of ≤60 mL/min 9 patients (17.0%) developed CIN compared to 132 patients (22.4%) of those with a CrCl of >60 mL/min (p=0.360). The prevention treatment with N–acetylcysteine, sodium bicarbonate or the combined N–acetylcysteine and sodium bicarbonate did not reduce the rate of CIN compared to hydration with intravenous NaCl infusion alone in patients with baseline CrCl of ≤60 mL/min (0% vs. 13.3% vs. 16.7% vs. 28.6%, p=NS) or in patients with a CrCl of >60 mL/min (21.1% vs. 20.9% vs. 21.3% vs. 26.4%, p=NS).
Prevention treatment with N–acetylcysteine and/or sodium bicarbonate was not superior in reducing the risk of CIN compared to NaCl in STEMI patients with or without baseline RI treated with primary PCI.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Complex Patients, Diabetes and Renal Insufficiency
Abstract Category: 43. TCT@ACC–i2: Complex Patients, Diabetes, Renal Insufficiency
Presentation Number: 2106–224
- 2013 American College of Cardiology Foundation