Contrast induced nephropathy after percutaneous coronary intervention： risk factors and preventive strategy

分析风险因素和对比的临床的结果的目的在经皮的冠的干预(一种总线标准)以后与冠的动脉疾病( CAD )在病人导致了 nephropathy ( CIN )并且讨论它的 prevention.Methods 有在收到了一种总线标准的 729 个病人之中的 CIN 的 54 个病人回顾地被学习并且相关风险因素，心血管的事件和预防策略是 analyzed.Results CIN 强烈与过程前被联系长期的肾的失败，糖尿病 mellitus 和

Prediction of contrast-induced nephropathy in diabetics undergoing elective percutaneous coronary intervention： role of the ratio of contrast medium volume to estimated glomerular filtration rate

Background Diabetic patients undergoing percutaneous coronary intervention （PCI） have a higher incidence of contrast-induced nephropathy （CIN） than nondiabetic patients, and no pharmacological approach has been demonstrated to offer consistent protection. Therefore, identifying individuals who are at increased risk becomes essential. This study was designed to assess the predictive role of the ratio of contrast medium volume to estimated glomerular filtration rate （CMV/eGFR） in diabetic patients undergoing elective PCI who developed ClN.Methods We retrospectively investigated clinical factors associated with the development of CIN in 114 diabetic patients who had undergone elective PCI. The risk factors for CIN included age, gender, body mass index （BMI）, left ventricular ejection fraction （LVEF）, hemoglobin （Hb）, fasting plasma glucose （FPG）, hemoglobin A1c （HbA1c）, volume of contrast medium, basic levels of serum creatinine （Scr）, the number of treated vessels and the number of stents used.We conducted a stepwise regression analysis to evaluate the predictive role of these risk factors in the incidence of CIN.Results The incidence of CIN was 18.4% （21/114）. There were no significant differences in age, gender, BMI, LVEF, Hb,FPG, HbA1c, and incidence of hypertension and number of acute myocardial infarction （AMI） in patients between the CIN （n=21） and the non-CIN （n=93） groups. However, the eGFR was significantly lower （（72.0±12.5） ml·min-1·1.73 m-2 vs.（82.0±16.5）ml·min-1·1.7m-2, P=0.010）, and the basic serum creatinine level （（1.07±0.12） mg/dl vs.（0.97±0.19） mg/dlP=0.014） was significantly higher in the CIN group. In addition, the volume of contrast medium was significantly larger （（253±75）ml vs. （211±71）ml, P=0.017） and the CMV/eGFR ratio was significantly greater （3.64±1.26 vs.2.70±1.11, P=0.001） in the CIN group. Stepwise regression analysis showed that the CMV/eGFR ratio was a significant independent predictor for the development of CIN （P=0.001）. At a cut-off point of 〉3.1, the CMV/eGFR ratio exhibited 71% sensitivity and 70% specificity for detecting CIN.Conclusion The CMV/eGFR ratio could be a valuable predictor of CIN for diabetic patients after elective PCI. At a cut-off point of〉3.1, the CMV/eGFR ratio was an optimal predictor for the incidence of CIN.

Contrast Induced Nephropathy after Radial or Femoral Access for Invasive Management of Acute Coronary Syndrome

Background: Percutaneous coronary intervention is now the best way of management of acute coronary syndrome (ACS). Contrast induced nephropathy is a serious complication and greatly dependent on several factors. It is still unclear whether the vascular access migrates CIN risk. Objective: To study the impact of Radial Access (RA) compared with Femoral Access (FA) on developing contrast-induced nephropathy (CIN) in patients undergoing invasive management of acute coronary syndrome (ACS). Methods: Sixty patients eligible for invasive management of ACS at cardiology department (Menoufia University hospital and National Heart Institute) were randomized into two groups. Group I: included 30 patients with femoral approach and Group II: included 30 patients with radial approach. The occurrence of CIN estimated by KDIGO definition (absolute increase in serum creatinine (SCr) by ≥0.5 mg/dl within 48 hours;or increase in SCr to ≥25% of baseline) was estimated in both groups. Results: Only 9 patients (15%) developed CIN, 5 patients (55.6%) of them underwent PCI through FA without statistically significant difference between the two approaches.Conclusion: CIN is considered a potential complication of percutaneous coronary intervention (PCI). Our study did not show the preference of using an approach over the other.

Volume-to-creatinine clearance ratio:a predictor for contrast-induced nephropathy in chronic kidney disease after primary percutaneous coronary intervention

The volume of contrast media to the creatinine clearance （V/CrCl） ratio correlate with the contrast-induced nephropathy （CIN）. The chronic kidney disease （CKD） more likely to develop CIN after primary percutaneous coronary intervention （PCI）. Objectiv has been shown to patients would be e To determine a relatively safe V/CrCl cutoff value to avoid CIN in CKD patients undergoing primary PCI. Methods We enrolled a total of 114 patients with CKD and calculated V/CrCl. Receiver-operator characteristic methods were used to identify the optimal sensitivity and specificity for the observed range of V/CrCl for CIN. We used multivariable logistic regression to assess the predictive value of V/CrCl for the risk of CIN in CKD patients. Results Overall, there were 24 cases （21%） of CIN. The baseline mean and median V/CrCl values were significantly greater among patients with CIN （mean 5.08 ±2.01, median 4.81, and interquartile range 3.53-6.33） than among those without CIN （mean 3.35 ±1.48, median 3.12, and interquartile range 2.27-4.14, P 〈 0.001）. The receiveroperator characteristic curve analysis indicated that a V/CrCl ratio of 3.62 was a fair discriminator for CIN （Cstatistic of 0.75） in CKD patients. After adjusting for other known predictors of CIN,a V/CrCl ratio 〉3.62 remained significantly associated with CIN in CKD patients（odds ratio 8.46,95% confidence interval 2.37-30.19, P 〈 0.001）. medium dose Conclusions based on the AV/CrCl ratio〉3.62 is a simple,useful indicator for determining the safe contrast pre-PCI CrCl values in CKDs.

Contrast-induced nephropathy after a second percutaneous coronary intervention in patients with chronic kidney disease

Background Data are limited regarding the risk of contrast-induced nephropathy （CIN） for patients after the second contrast exposure. Objective To examine the risk of CIN after the second contrast exposure in patients of acute coronary syndrome （ACS） with chronic kidney disease （CKD）. Methods Patients of ACS scheduled for a second elective PCI. Patients were required to have an estimated creatinine clearance （CrCl） between 15 and 60 ml/min. The value of serum creatinin （sCr） prior to the second contrast exposure must not be ≥ 25% or ≥ 88.4 μmol/L compared to baseline. CIN was defined as an increase of sCr ≥ 25% from baseline within 45-72h after the second contrast exposure. The primary end-point was risk of developing CIN. Results Thirty-nine patients completed the study. The average of interval between contrast exposures was 116 ± 64 h, contrast volume was 266 ± 100 mL and length of hospitalization was 8.3 ± 4.7 days. The incidence of CIN in the overall study population was 10.3%. There was not change significantly in average sCr and CrC1 after the second contrast exposure （sCr 1.52±0.62 vs. 1.54 ± 0.60 mg/dL baseline, P = 0.75; CrC1 （40.68 ± 14.46 vs. 39.16 ± 12.10 mL/min baseline, P = 0.26）. None of the patient was death in 30 days. One （2.6%） of the patients who developed CIN required dialysis in-hospital. Conclusion Our findings suggest that patients with prior renal dysfunction are not increased risk of developing CIN after the second contrast exposure. This cohort may be benefit from sufficient prophylaxis.

Higher hydration volume may not reduce the risk of contrast-induced nephropathy in patients with chronic kidney disease undergoing percutaneous coronary intervention

Background Adequate hydration with isotonic saline is generally recommended to prevent contrast-induced nephropathy （CIN） in patients with chronic kidney disease （CKD）. However, there is no well-defined protocol regarding the optimal rate and duration of normal saline administration. Methods Patients with CKD （estimated glomerular filtration rate [eGFR] 〈60 mL/min/1.73 m^2） undergoing PCI with hydration at the speed recommend-ed by the current guidelines （1 mL/kg/h [0.5 ml/kg/h for left ventricular ejection fraction 〈40% or severe conges-tive heart failure]） were included in the study （n=631）. CIN was defined as an increase in serum creatinine of I〉 0.5 mg/dL or 25% from the baseline within 48-72 hours after contrast exposure. Results Individuals with high-er adequate hydration （HV/W ratios） were more likely to develop CIN （Q1, Q2, Q3, and Q4： 6.33%, 18.4%, 12.5%, and 21.52%, respectively; P=0.001）, acute heart failure （5.7%, 6.13%, 9.21%, and 13.92%, respectively; P=0.035）. Multivariate analyses showed that higher hydration volume was not significantly associated with a re-duced risk of CIN （HV/W ratio Q2 vs. QI： odds ratio [OR]： 2.36, 95% confidence interval [CI]： 1.08-5.16; Q3 vs. QI： OR： 1.47, 95% CI： 0.63-3.4; Q4 vs. QI：OR： 2.32, 95% CI： 1.05-5.11）. Conclusion Higher hydration volume may not reduce the risk of contrast-induced nephropathy in patients with CKD undergoing PCI.intravascular hydration volume at routine speed may not decrease the risk of CIN in patients with chronic kidney disease Undergoing percutaneous coronary intervention.

Relationship between hyperuricemia and contrast-induced nephropathy in patients after emergent percutaneous coronary intervention

Background Few studies have investigated the role of serum uric acid （SUA） on the risk of contrast-in- duced nephropathy（CIN） in patients with acute coronary syndrome （ACS） after emergent percutaneous coronary intervention（PCI）. The present study was conducted to investigate the relationship between hyperuricemia （HUA） and CIN in patients after emergent PCI. Methods A total of 558 consecutive patients with ACS undergoing emergent PCI in Fujian Provincial Hospital were enrolled in this study. Patients were divided into hyperuricemic group （n=136） and normouricemic group （n=422）. Hyperuricemia was defined as SUA 〉420 μmol/L for male, 〉 360 txmol/L for female. CIN was defined as an absolute ≥44.2 μmol/L（0.5 mg/dL） increase inthe serum creati- nine （SCr） level within 72 hours after contrast medium exposure. In hospital incidences of CIN and the major adverse cardiac events were compared between the two groups. The relationship between the incidence of CIN and HUA was evaluated by multivariate logistic regression analysis. Results Among the 558 patients, CIN was observed in 34（6.1%） patients, and incidence of CIN was significantly higher in the HUA group than in the normou- ricemic group [13.2% （18/136） vs. 3.8%（16/422）, P 〈 0.001]. SUA concentration was significantly higher in CIN group compared with that in non - CIN group [ （490.21±76.48 μmol/L） vs. （307.00±65.37μmol/L）, P 〈 0.001]. Need for renal replacement therapy （RRT）, congestive heart failure （CHF）, in hospital mortality after PCI were significantly higher in the HUA group compared with Normouricemic group （all P〈0.05）. Patients who devel- oped CIN had higher in hospital mortality [44.1% （15/34） vs. 2.9 % （15/524）, P 〈 0.001 ]. Multivariate analysis in- dicates that HUA（OR=3.020, 95% CI： 1.3340- 6.805, P 〈 0.001）, Intra- aortic balloon pump （IABP） use （OR= 15.724,95% CI： 3.913-63.179, P 〈 0.001） and Perioperative hypotension（OR=3.342, 95% CI： 1.373-8.138, P 〈 0.01） were predictors of CIN in patients after emergent percutaneous coronary intervention. Conclusion Hyper- uricemia is the independent risk predictor of CIN in patients with ACS undergoing emergent PCI.

The SYNTAX score as a predictor of contrast-induced nephropathy patients with chronic total occlusion undergoing percutaneous coronary intervention

Background The SYNTAX score was developed to assess the severity and complexity of coronary artery disease and was determined to be effective in predicting contrast-induced nephropathy（CIN） in patients with STelevation myocardial infarction（STEMI） and non-STEMI（NSTEMI）. However, the relationship between SYNTAX score and CIN of patients with CTO undergoing PCI has been unclear. Methods We retrospectively enrolled 667 patients with CTO who underwent our institution′s basic PCI protocol between January 2010 and September 2012. The patients were divided into 3 groups： a low-risk group（SYNTAX score 〈 23; n = 231）, a moderate-risk group（SYNTAX score = 23-32; n = 214）, and a high-risk group（SYNTAX score〉32; n = 222）. CIN was defined as an absolute increase in SCr of ≥ 0.5 mg/d L over baseline values within 48-72 h after administration of contrast medium. We observed the correlation between SYNTAX score and the CIN rates. Results CIN developed in 74（11.09%） of the 667 study patients. The CIN rate showed a positive trend in the 3 groups based on the SYNTAX score, the higher SYNTAX score corresponds to the higher incidence of CIN（6.93%,13.08%,13.51%P = 0.044）. In the multivariate analysis, SYNTAX score was identified as an independent predictor of CIN（OR：1.956,95% CI： 1.014-3.773; P = 0.045; OR： 1.942,95% CI： 1.005-3.752; P = 0.048）. The incidence of in-hospital（1.3% vs. 4, 21% vs. 5.86%, P = 0.035） and long-term MACE（4.59% vs. 7.88% vs. 11.66%, P = 0.046） rates were more frequent in the higner SYNTAX score groups. Conclusions SYNTAX score is an independent predictor of CIN among patients with CTO undergoing PCI.

Relationship between composite hydration volume (Intravenous plus oral) and contrast-induced nephropathy after emergent percutaneous coronary intervention

Background Few studies have investigated the safe limits of total intravenous plus oral hydration to prevent contrast-induced nephropathy （CIN）. The present study was conducted to evaluate the effects of different composite hydration rate （intravenous plus oral） on CIN prevention in patients undergoing emergent percutaneous coronary intervention （PCI）. Methods This was a retrospective observational study that included 307 eligible patients, who were stratified into quartiles of rate of the composite hydration volumn to body weight and time （HV/ W/T）. CIN was defined as an absolute≥0.5 mg/dL or a relative ≥25% increase in the serum creatinine level within 72 hours after the procedure. Results In terms of risks of CIN, there were no statistical differences among individuals in four groups with different composite HV/W/T （27.6%, 19.0%, 23.0%, and 26.9% respectively in quartiles Q1, Q2, Q3, and Q4, P=0.565）. Additionally, higher composite hydration ratio seemed not to decrease the risk of in-hospital death, worsening heart failure and stroke （all P〉0.05）. After adjusting for other risk factors, multivariate analysis showed no statistical difference between Q2, Q3 or Q4, compared with Q1 （Q2 vs. QI： adjusted odds ratio [OR], 0.67, P=0.383; Q3 vs QI： adjusted OR, 0.77, P=0.550; Q4 vs. QI： adjusted OR, 0.75, P= 0.489）. Conclusion Excessive composite hydration may not provide supplemental benefit of CIN prevention and in-hospital outcomes in patients following emergent PCI, and moderate and prophylactic hydration is warranted.

Contrast-induced nephropathy after staged percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease

Background Contrast-induced nephropathy（CIN） occurs frequently in patients undergoing primary percutaneous coronary intervention（PCI） for ST-segment elevation myocardial infarction（STEMI） and is associated with poor outcomes. Multivessel coronary artery disease（MVCAD） is considered to be a potentially important risk factor for CIN. There are still no data on CIN in patients undergoing staged PCI for STEMI and MVCAD. Therefore, we explored the incidence, risk factors, in-hospital and follow-up outcomes of CIN in this special population. Methods From 2011 to 2018, we enrolled 103 consecutive patients with STEMI who underwent staged PCI for MVCAD. CIN was defined as a relative increase of 〉 25% or an absolute increase of ≥ 0.5 mg/dL in SCr from the baseline value 72 h after exposure to the contrast medium. The incidence, risk factors, in-hospital and follow-up outcomes of CIN in this special population were studied. Results We found1） the incidence of CIN after primary PCI and staged PCI was 16.50% and 25.20%, respectively. 2） patients with CIN had worse in-hospital and follow-up outcomes. 3） in multivariate logistic analysis, independent risk factors for CIN included：（1） lower creatinine clearance at baseline;（2） atrioventricular block requiring temporary cardiac pacemaker implantation;（3） use of IABP at baseline;（4） total contrast volume administered（ primary PCI ＋staged PCI）;（5） shorter time interval between primary PCI and staged PCI. Conclusions CIN is a frequent complication in patients with STEMI and MVCAD undergoing staged PCI. The development of CIN is associated with worse in-hospital and follow-up outcomes.

Role of serum cystatin C in the prediction of contrast-induced nephropathy after intra-arterial interventions

Background:The diagnosis of contrast-induced nephropathy(CIN)is usually based on changes in serum creatinine(sCr).However,sCr has poor sensitivity as a biomarker of kidney injury.The aim of this study was to investigate the usefulness of serum cystatin C(sCysC)to predict CIN after intra-arterial interventions.Methods:A total of 360 consecutive patients underwent intra-arterial procedures using digital subtraction angiography.SCr,sCysC,and estimated glomerular filtration rate were measured at 1 to 2 days before and at 48,72 h,and 7 days after the procedure.Results:Thirty-one patients(8.61%)developed CIN.Receiver operating characteristic(ROC)curve analysis showed that preoperative sCysC levels had good discriminatory power(area under the curve[AUC]=0.634;95%confidence interval[CI]=0.526-0.743)for evaluating the risk of CIN after an endovascular procedure,with a sensitivity of 53.33%and specificity of 73.70%.ROC analysis showed that sCysC at 48 h after contrast medium administration was predictive of CIN after an endovascular procedure(AUC=0.735;95%CI=0.647-0.822)with satisfactory sensitivity of 74.20%and specificity of 63.90%.Diabetes mellitus was an independent risk factor for CIN(odds ratio=2.778;95%CI=1.045-7.382;P=0.040).Conclusions:SCysC is an appropriate biomarker to predict the occurrence of CIN.Baseline sCysC before an intervention is useful to obtain a preliminary estimate of the risk of CIN.A 48-h cut-off value of sCysC of 0.99 mg/L after an endovascular procedure may help to rule out patients at lower risk of CIN.

Risk Factors of Contrast-induced Acute Kidney Injury in Patients Undergoing Emergency Percutaneous Coronary Intervention

Background： Previous studies of contrast-induced acute kidney injury （CI-AK1） were mostly based on selective percutaneous coronary intervention （PCI） cases, and risk factors of CI-AKI after emergency PCI are unclear. The aim of this study was to explore the risk factors of CI-AKi in a Chinese population undergoing emergency PCI. Methods： A total of 1061 consecutive patients undergoing emergency PCI during January 2013 and June 2015 were enrolled and divided into CI-AK1 and non-CI-AKl group. Univariable and multivariable analyses were used to identity the risk factors of CI-AKI in emergency PCI patients. CI-AKI was defined as an increase in serum creatinine ≥25% or ≥0.5 mg/dl （44.2 μmol/L） above baseline within 3 days alter exposure to contrast medium. Results： The incidence of C1-AKI in patients undergoing emergency PCI was 22.7% （241/1061）. Logistic multivariable analysis showed that body surface area （BSA） （odds ratio [OR] 0.213, 95% confidence interval [CI]： 0.075-0.607, P = 0.004）, history, of myocardial infarction （MI） （OR 1.642, 95% CI. 1.079-2.499, P- 0.021 ）, left ventricular ejection fraction （LVEF） （OR 0.969, 95% CI： 0.944-0.994, P = 0.015）, hemoglobin （Hb） （OR 0.988, 95% CI. 0.976-1.000, P 1.018 1.037, P 〈 0.001 ）, left anterior descending （LAD） stented （OR 1 0.009 0.987, P- 0.049）, and diuretics use （OR 1.850, 95% CI： 1.233-2 0.045）, estimated glomerular filtration rate （OR 1.027, 95% CI： 464, 95% CI： 1.000 2.145, P 0.050）, aspirin （OR 0.097, 95%CI： .777, P - 0.003） were independent predictors of CI-AKI in patients undergoing emergency PCI. Conclusion： History of MI, low BSA, LVEF and Hb level, LAD stented, and diuretics use are associated with increased risk of CI-AK1 in patients undergoing emergency PCI.

Impact of benazepril on contrast-induced acute kidney injury for patients with mild to moderate renal insufficiency undergoing percutaneous coronary intervention

Background The role of angiotensin-converting enzyme inhibitors （ACEI） in contrast-induced acute kidney injury （CI-AKI） is controversial. Some studies pointed out that it was effective in the prevention of CI-AKI, while some concluded that it was one risk for CI-AKI, especially for patients with pre-existing renal impairment. The purpose of this study was to assess the influence of benazepril administration on the development of CI-AKI in patients with mild to moderate renal insufficiency undergoing coronary intervention.Methods One hundred and fourteen patients with mild to moderate impairment of renal function were enrolled before coronary angioplasty, who were randomly assigned to benazepril group （n=52） and control group （n=62）. In the benazepril group, the patients received benazepril tablets 10 mg per day at least for 3 days before procedure. CI-AKI was defined as an increase of≥25％ in creatinine over the baseline value or increase of 0.5 mg/L within 72 hours of angioplasty.Results Patients were well matched with no significant differences at baseline in all measured parameters between two groups. The incidence of CI-AKI was lower by 64％ in the benazepril group compared with control group but without statistical significance （3.45％ vs. 9.68％, P=0.506）. Compared with benazepril group, estimated glomerular filtration rate （eGFR） level significantly decreased from （70.64＋16.38） ml·min-1·1.73 m-2 to （67.30＋11.99） ml·min-1·1.73 m-2 in control group （P=0.038）. There was no significant difference for the post-procedure decreased eGFR from baseline （△eGFR）between two groups （benazepril group （0.67＋12.67） ml·min-1·1.73 m-2 vs. control group （-3.33±12.39） ml·min-1·1.73 m-2,P=0.092）. In diabetic subgroup analysis, △eGFR in benazepril group was slightly lower than that in the control group, but the difference was not statistically significant.Conclusions Benazepril has a protective effect on mild to moderate impairment of renal function during coronary angioplasty. It is safe to use benazepril for treatment of patients with mild to moderate impairment of renal function before coronary intervention.

Relationship between High Level of Estimated Glomerular Filtration Rate and Contrast-Induced Acute Kidney Injury in Patients who Underwent an Emergency Percutaneous Coronary Intervention

Background： Mounts of studies have shown that low estimated glomerular filtration rate （eGFR） is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury （CI-AKI） in a Chinese population who underwent an emergency percutaneous coronary intervention （PCI）. Methods： Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint （including nonfatal myocardial infarction, revascularization, stroke, and all-cause death） at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was performed.Results： A total of 1061 patients were included and the overall CI-AKI rate was 22.7% （241 / 1061）. The separate rates were 77.8% （7/9） in Group 1 （eGFR 〉 120 ml·min^-1 -1.73 m^-2）, 26.0% （118/454） in Group 2 （120 ml·min^-1·min^-11.73 m^-2〉 eGFR≥90 ml·min^-1 1.73^-2）, 18.3% （86/469） in Group 3 （90 ml·min^-1 1.73 m^-2〉 eGFR 〉60 ml·min^-1·min^-11.73 m^-2）, 21.8% （26/119） in Group 4 （60 ml·min^-1·1.73 m^-2〉 eGFR≥30 ml·min^-1·min^-11.73 m^-2）, and 40.0% （4/10） in Group 5 （eGFR 〈30 ml·min^-1·min^-1·min^-11.73 m^-2）, with statistical significance （χ^2 = 25.19, P 〈 0.001）. The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing （the higher the level of eGFR, the higher the CI-AKI occurrence in case ofeGFR_〉60 ml·min^-1·1.73 m^-2）. The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences （χ^2 = 16.26, P = 0.009 at 6-month follow-up, and χ^2 = 49.05, P 〈 0.001 at 12-month follow-up）. The logistic analysis confirmed that eGFR was one of independent risk factors of CI-AKI in emergency PCI patients. Conclusions： High level ofeGFR might be associated with increased risk of CI-AKI in patients with emergency PCI, implying for future studies and risk stratification in clinical practice.

达格列净对老年2型糖尿病患者介入治疗术后造影剂肾病的发生及心血管预后的影响

目的探讨达格列净对老年(年龄>60岁)2型糖尿病(T2DM)患者行经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)的发生及预后的影响。方法回顾性选取2021年1月至2022年6月于天津大学胸科医院心内科行PCI老年T2DM患者296例,应用倾向性评分匹配以1:1比例进行分组,根据是否应用达格列净分为达格列净组148例和对照组148例。匹配后记录2组PCI术前、PCI术后72 h肾功能,包括血尿素、血清肌酐、估算肾小球滤过率、β_(2)微球蛋白(β_(2)-MG)、胱抑素C(Cys C)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的变化;记录2组CIN发生率,应用二元logistic回归分析达格列净对CIN发生率的影响;记录2组随访期间主要不良心脏事件(MACE)发生情况,应用Kaplan-Meier曲线分析和log rank检验比较2组MACE发生的差异。结果2组一般临床资料比较无显著差异(P>0.05);PCI术后72 h,2组血清Cys C、β_(2)-MG、NGAL水平均高于PCI治疗前,且达格列净组Cys C、β_(2)-MG、NGAL水平均低于对照组,差异有统计学意义(P<0.05,P<0.01)。达格列净组CIN发生率低于对照组(4.7%vs 12.2%,P=0.035)。二元logistic回归分析显示,达格列净是CIN的独立保护因素(OR=0.256,95%CI:0.083~0.796,P=0.019)。平均随访(14.25±2.15)个月,达格列净组MACE发生率低于对照组(χ_(Log rank)~2=5.257,P=0.022;HR=0.460,95%CI:0.237~0.893)。结论达格列净可能减少老年T2DM患者PCI术后CIN及MACE的发生。

Mehran评分用于老年人群造影剂肾病风险评估效果分析

目的验证Mehran评分用于老年冠状动脉粥样硬化性心脏病(简称冠心病)人群造影剂肾病(CIN)风险评估的效果。方法收集上海某院心血管内科2015年1月至2017年12月行经皮冠状动脉介入(PCI)术老年(>65岁)患者的临床资料(包括基本信息、合并症、实验室指标及合并用药情况),采用单因素和二元Logistic回归分析评估发生CIN的危险因素及与Mehran评分的相关性。结果共纳入378例患者,其中45例(11.90%)围术期发生CIN,Mehran分级为低危(≤5分)、中危(6~10分)、高危(11~15分)、极高危(≥16分)的患者分别有182例、147例、41例、8例,且各组患者CIN发生率差异有统计学意义(P<0.05)。二元Logistic回归分析结果表明,术前预估肾小球滤过率(eGFR)[OR=0.939,95%CI(0.883,0.998),P=0.044]及Mehran危险分级为高危[OR=3.414,95%CI(1.116,10.441),P=0.031]和极高危[OR=9.604,95%CI(1.311,70.355),P=0.026],是预测老年冠心病患者PCI术后发生CIN的重要因素。结论术前eGFR及Mehran危险分级为高危、极高危,为预测老年冠心病患者PCI术后CIN发生风险的影响因素。

老年急性冠脉综合征患者PCI术前血清miR-34a、miR-182水平与术后对比剂肾病发生的相关性

目的 探究老年急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术前血清微小RNA(miR)-34a、miR-182水平与术后对比剂肾病(CIN)发生的关系。方法 纳入行PCI治疗的146例老年ACS患者。收集ACS患者临床资料;全自动生化分析仪检测术前血脂、肾功能指标;实时荧光定量PCR法测定血清miR-34a、miR-182水平。根据患者PCI术后是否发生CIN分为CIN组(20例)和非CIN组(126例)。比较CIN组和非CIN组临床资料、术前血脂、肾功能指标、血清miR-34a、miR-182、术后血清肌酐(Scr)、肾小球滤过率(eGFR)水平;分析老年ACS患者术前血清miR-34a、miR-182、术后Scr、eGFR的相关性及影响老年ACS患者PCI术后发生CIN的因素,受试者工作特征(ROC)曲线评估术前血清miR-34a、miR-182水平对老年ACS患者PCI术后发生CIN的预测价值。结果 CIN组术前血清miR-34a和miR-182水平、术后Scr水平均高于非CIN组,术后eGFR水平低于非CIN组(P<0.05);ACS患者术前血清miR-34a、miR-182与术后Scr呈正相关,与术后eGFR呈负相关(P<0.05);术前血清miR-34a与miR-182呈正相关(P<0.05);术前血清miR-34a、miR-182水平升高是影响老年ACS患者PCI术后发生CIN的独立危险因素(P<0.05);术前血清miR-34a、miR-182及两者联合预测老年ACS患者PCI术后发生CIN的曲线下面积(AUC)分别为0.881、0.888、0.964,两者联合预测的AUC高于各自单独预测(P<0.05)。结论 术前血清miR-34a、miR-182水平升高是老年ACS患者PCI术后发生CIN的危险因素,两者联合可有效预测CIN的发生。

血清高敏C反应蛋白/白蛋白与急性冠状动脉综合征PCI术后对比剂肾病的相关性

目的 分析血清高敏C反应蛋白(hs-CRP)/白蛋白(Alb)与急性冠状动脉综合征患者经皮冠状动脉介入(PCI)术后对比剂肾病的相关性。方法 选取我院接受PCI的496例急性冠状动脉综合征患者作为研究对象,根据PCI术后是否发生对比剂肾病分为对比剂肾病组(n=56)和非对比剂肾病组(n=440)。采用ELISA法检测患者术前血清hs-CRP水平,使用血液分析仪测定术前血清Alb水平,并计算hs-CRP/Alb。Logistic回归分析急性冠状动脉综合征患者PCI术后发生对比剂肾病的影响因素;受试者工作特征(ROC)曲线分析血清hs-CRP/Alb对急性冠状动脉综合征PCI术后对比剂肾病的预测价值。结果 与非对比剂肾病组相比,对比剂肾病组患者术前血清hs-CRP水平、hs-CRP/Alb均明显升高(P<0.001),Alb水平显著下降(P<0.001)。与非对比剂肾病组相比,对比剂肾病组患者术前肌酐水平、对比剂剂量明显升高(P<0.05);对比剂肾病组患者术后肌酐水平显著高于术前(P<0.05),术后血尿酸显著低于术前(P<0.05)。Logistic回归分析显示,hs-CRP、hs-CRP/Alb、肌酐水平、对比剂剂量是急性冠状动脉综合征患者PCI术后发生对比剂肾病的危险因素(P<0.05),Alb是保护因素(P<0.05)。ROC曲线显示,血清hs-CRP/Alb预测急性冠状动脉综合征患者PCI术后对比剂肾病的曲线下面积为0.965,截断值为0.19。结果 急性冠状动脉综合征患者术前血清hs-CRP/Alb较高与PCI术后发生对比剂肾病相关,其对急性冠状动脉综合征PCI术后发生对比剂肾病具有一定的预测价值。

在充分水化基础上碳酸氢钠联合乙酰半胱氨酸对减少造影剂肾病的作用

目的评价在充分水化基础上碳酸氢钠(Sodium Bicarbonate,SB)联合N-乙酰半胱氨酸(N-acetylcysteine,NAC)对慢性肾脏病(Chronic Kidney Disease,CKD)的冠状动脉粥样硬化性心脏病(简称冠心病)(Coronary Heart Disease,CHD)患者减少造影剂肾病(Contrast-Induced Nephropathy,CIN)的作用。方法随机选取2020年8月-2022年7月在广西壮族自治区民族医院行经皮冠状动脉介入治疗(Percutaneous Coronary Interven⁃tions,PCI)的120例CKD患者为研究对象,使用随机数表法分为常规治疗组(NS组)、碳酸氢钠(SB组)、乙酰半胱氨酸组(NAC组)、碳酸氢钠联合乙酰半胱氨酸组(SB+NAC组),每组30例。NS组于PCI术前给予持续水化治疗;SB组在NS组基础上给予SB;NAC组在NS组基础上于术前和术后口服N-乙酰半胱氨酸泡腾片。SB+NAC组在SB组基础上同NAC组处理。分析4组患者在术前及PCI术后48 h血清指标血肌酐(Serum Cre⁃atinine,SCr)、胱抑素C(Cystatin C,Cys-C),计算肌酐清除率(Creatinine Clearance Rate,Ccr),估算记录肾小球滤过率(Estimated Glomerular Filtration Rate,eGFR)。结果NS组、SB组、NAC组、SB+NAC组患者术后eGFR、Ccr、SCr、Cys-C比较,差异有统计学意义(P均<0.05)。NS组、SB组、NAC组、SB+NAC组患者发生CIN例数分别为7例、5例、3例、0,4组患者CIN发生率比较,差异有统计学意义(χ^(2)=8.152,P<0.05)。结论水化基础上碳酸氢钠、N-乙酰半胱氨酸以及两者联合应用有效减少CKD患者行PCI术后CIN的发生,具有一定效果,且两种药物联合应用要优于单独应用。

注射用尼可地尔对于急性心肌梗死患者直接经皮冠状动脉介入治疗后对比剂肾病预防效果的临床研究

目的评估注射用尼可地尔对于ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)后对比剂肾病的预防效果。方法本研究纳入2018年至2019年国内多家中心拟行直接PCI的STEMI患者,随机分为尼可地尔组和安慰剂组,分别在直接PCI术前静脉注射尼可地尔或安慰剂。围术期观察患者血肌酐水平的变化,研究终点为对比剂肾病的发生,定义为术后48~72 h的血肌酐相较基线血肌酐水平增加超过0.5 mg/dl或与基线血肌酐相比相对增加超过25%。结果最终研究人群纳入了行直接PCI的238例STEMI患者,其中226例(尼可地尔组和安慰剂组各113例患者)完成了围术期肾功能的检测。与安慰剂组相比,尼可地尔组最终心肌梗死溶栓治疗试验(TIMI)血流分级水平显著提高(P=0.001),并且尼可地尔组对比剂肾病的发生率明显降低(9.7%比24.8%,P=0.003)。多因素Logistic回归分析显示注射用尼可地尔与对比剂肾病的发生率降低显著相关(OR 0.379,95%CI 0.16~0.86,P=0.021)。结论尼可地尔是接受直接PCI手术的STEMI患者发生对比剂肾病的独立保护性因素。在直接PCI术前静脉注射尼可地尔可以有效预防STEMI患者术后对比剂肾病的发生。