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An invasive approach improves outcomes in patients with acute coronary syndromes (ACS) but is associated with the increased risk of contrast induced nephropathy (CIN). The predictors of CIN persistence until discharge (despite of specific treatment) has not been fully analyzed in ACS patients. The aim was to determine the factors influencing the presence of CIN at discharge (CIN criteria met at discharge) in ACS patients referred to coronary angiography / PCI.
A total of 2,638 patients with ACS (959 STEMI, 1767 with PCI immediately after angiography) were analyzed based on prospective single center registry. Discharge comparing to baseline creatinine level was analyzed for CIN at discharge diagnosis (25% increase in serum creatinine from baseline or 0.5 mg/dL (44 μmol/L) increase in absolute value).
The rate of CIN at discharge was similar in patients with normal and elevated creatinine level at baseline (10.4 vs 11.9%; p=0.3) and with normal and reduced creatinine clearance (10.0 vs 11.9%; p=0.2) but it was higher in patients with anemia at baseline comparing to non-anemia patients (17.9 vs 10%; p<0.001) and in patients with PCI immediately after angiography comparing to other treatment strategies (12.2 vs 7.8%; p<0.001). In multivariable regression analysis, anemia at baseline (HR 1.97; 95%CI 1.37-2.83) was found as the only independent predictor of CIN at discharge.
Despite specific treatment, CIN at discharge is present in more than 10% of patients with ACS referred to coronary angiography / PCI. Anemia at baseline is an independent predictor of CIN thus targeted preventive actions should be considered in anemic patients.
OTHER: Renal Insufficiency and Contrast Nephropathy