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Original Research

Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction: Is it Affected by Treatment Strategy?

Authors:

Mohamed Khalfallah ,

Department of Cardiology, Tanta University Hospital, Tanta, EG
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Mohamed Abdalaal,

Department of Cardiology, Tanta University Hospital, Tanta, EG
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Mona Adel

Department of Cardiology, Tanta University Hospital, Tanta, EG
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Abstract

Background: Contrast-induced nephropathy (CIN) is a frequent complication after percutaneous coronary intervention (PCI) and severely affects morbidity and mortality, especially in patients with ST-segment elevation myocardial infarction.

Objective: This study sought to determine the incidence, risk factors, and in-hospital outcome of CIN in patients with ST-segment elevation myocardial infarction managed by pharmacoinvasive strategy (PIS) versus those managed by primary PCI (PPCI).

Methods: The study was conducted on 670 patients with ST-segment elevation myocardial infarction divided into 2 groups: group I (PPCI group) and group II (PIS group), the 2 groups were compared with each other for the incidence of CIN, risk factors, and in-hospital major adverse cardiac events.

Results: The incidence of CIN in the PIS group (30 patients, 8.8%) was lower than PPCI group (36 patients, 10.9%); however, there was no statistically significant difference between the 2 groups (p = 0.365). Multivariate regression analysis showed that advanced age >60 years (odds ratio [OR] = 4.453; 95% confidence interval [CI]: 2.489 to –7.967; p = 0.001), history of diabetes mellitus (OR = 2.366; 95% CI: 1.298 to –4.315; p = 0.005) and hypertension (OR = 1.930; 95% CI: 1.053 to –3.539; p = 0.034), volume of contrast agent >180 ml (OR = 2.276; 95% CI: 1.290 to –4.016; p = 0.005), and cardiogenic shock (OR = 4.098; 95% CI: 1.726 to –9.728; p = 0.001) were the independent predictors of CIN. Mortality and major adverse cardiac events were significantly higher in patients with CIN.

Conclusions: The incidence of CIN was slightly lower in PIS as compared to PPCI; however, this reduction was not statistically significant. The independent predictors of CIN were advanced age, history of diabetes mellitus and hypertension, high dose of contrast agent, and cardiogenic shock.

Highlight

  • The incidence of CIN was not significantly correlated to the strategy of management of patients with STEMI, although prophylactic measures against CIN should be taken in high-risk patients.
  • Patients with CIN have a higher incidence of increased hospitalization, in-hospital morbidity, and mortality.
  • Risk factors for CIN were advanced age, history of diabetes mellitus and hypertension, high dose of contrast agent, and cardiogenic shock.
How to Cite: Khalfallah M, Abdalaal M, Adel M. Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction: Is it Affected by Treatment Strategy?. Global Heart. 2019;14(3):295–302. DOI: http://doi.org/10.1016/j.gheart.2019.07.001
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Published on 01 Sep 2019.
Peer Reviewed

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