Author + information
- Navin Chandraa,b,
- Imad Nadraa,b,
- Sean Hardimana,b,
- Lillian Dinga,b,
- Anthony Funga,b,
- Eve Aymonga,b,
- Albert Chana,b,
- Stephen Hodgea,b,
- Simon Robinsona,b,
- Anthony Della Siegaa,b and
- Bilal Iqbala,b
Background: Renal function-based contrast dosing to limit renal injury following percutaneous coronary intervention (PCI) has been studied but its prognostic relevance is unknown. We evaluated the contrast volume: glomerular filtration rate (GFR) ratio (R) to define “prognostic” limits for contrast dosing for PCI in stable disease, non-ST elevation ACS (NSTEACS), and ST-elevation ACS (STEACS).
Methods: We analyzed 44,082 non-dialysis patients who had PCI from 2008-2014 in British Columbia. We determined R for each patient (range:1-10) and its relationship with 1 year mortality was modelled mathematically and analysed using Cox regression.
Results: Multivariable analyses identified R as a strong predictor of mortality (HR=1.03, 95% CI: 1.02-1.04, p<0.001). There was an exponential relationship between R and mortality (figure 1A), and for every unit increase in R, the 1 year mortality increased by 22% in stable patients; 31% in NSTEACS and 29% in STEACS. When analyzing adjusted mortality (figure 1B), the maximum “prognostic” limit of R varied by indication for PCI: Rstable=9, RNSTEACS=6 and RSTEACS=6.
Conclusions: When using mortality to define “prognostic” contrast limits, the maximum contrast:GFR ratio is 9 and 6 for stable and unstable patients respectively. These limits are greater than those derived previously. Whilst these data stress the importance of using less contrast, when considering prognostic parameters, a greater contrast volume may ultimately be tolerated in patients undergoing PCI.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1166-316
- 2017 American College of Cardiology Foundation