Author + information
- Per Thayssen,
- Henrik Steen Hansen,
- Anne Kaltoft,
- Jan Ravkilde,
- Knud Noerregaard Hansen,
- Hans Erik Bøtker,
- Hans–Henrik Tilsted,
- Anders Junker,
- Leif Thuesen,
- Karsten T. Veien and
- Lisette Okkels Jensen
Contrast–induced nephropathy (CIN) is a serious condition in patients with ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). The risk of persistent renal dysfunction after CIN is limited studied. We investigated the risk of acute CIN and persistent renal dysfunction and the influence of preventive strategies in STEMI patients undergoing primary PCI.
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 alone. Patients with cardiogenic shock were excluded. Acute CIN was defined as an increase in S–Cr concentration >25% from the baseline value within a 3–day period after primary PCI.
Overall, CIN occurred in 141 (21.9%) patients. The prevention treatment with N–acetylcysteine, sodium bicarbonate or the combined N–acetylcysteine and sodium bicarbonate did not reduce the rate of CIN significantly compared to hydration with intravenous NaCl infusion alone (20.1% vs. 20.1% vs. 20.8% vs. 26.5%, p=NS). An increase in S–Cr >25% from the baseline value to 30–day was significantly lower in patients treated with combined N–acetylcysteine and sodium bicarbonate (18.7% vs. 19.1% vs. 9.2% vs. 21.3%, p=0.033). Persistent renal dysfunction after 30 days in patients with acute CIN within 3 days was documented in 55 (48.2%) patients (57.7% vs. 56.0% vs. 29.6% vs. 50.0%, p=0.150).
Persistent renal dysfunction after 30 days was seen in half of the patients with acute CIN. Combined treatment with N–acetylcysteine and sodium bicarbonate reduced the risk of renal dysfunction after 30 days.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Acute Coronary Syndrome and Acute Myocardial Infarction
Abstract Category: 40. TCT@ACC–i2: ACS/AMI/Hemodynamic Support
Presentation Number: 2113–256
- 2013 American College of Cardiology Foundation