Clinical Predictors of Contrast-Induced Acute Kidney Injury in Patients Undergoing Emergency Versus Elective Percutaneous Coronary Intervention:– Results From the Ibaraki Cardiovascular Assessment Study Registry –
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概要
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Background: To evaluate the incidence and clinical predictors of contrast-induced acute kidney injury (CI-AKI) in patients with ST-segment elevation myocardial infarction (STEMI), unstable angina pectoris/non-STEMI (UAP/NSTEMI), and stable AP (SAP) undergoing percutaneous coronary intervention (PCI). Methods and Results: We enrolled 1,954 patients (SAP, n=1,222; UAP/NSTEMI, n=277; STEMI, n=455) who underwent PCI. Patients were categorized according to contrast media volume/estimated glomerular filtration rate ratio (CV/eGFR low: <2.0, mid: 2.0–2.9, high: ≥3.0). CI-AKI was defined as an increase in serum creatinine of 0.5mg/dl or 25% within 1 week from contrast-medium injection. The incidence of CI-AKI was highest among the STEMI patients (SAP, 4.24%; UAP/NSTEMI, 10.7%; STEMI, 16.1%, P<0.01). Significant predictors of CI-AKI were emergency PCI (odds ratio [OR] 3.70; 95% confidence interval [CI] 2.55–5.37; P<0.001), ejection fraction <40% (OR 2.04; 95% CI 1.24–3.36; P=0.005), and hemoglobin <10g/dl (OR 0.02; 95% CI 1.17–4.55; P=0.02) after multivariate logistic regression analysis. In the SAP group, a CV/eGFR ratio ≥3.0 was a significant predictor of CI-AKI (P=0.048), but not in UAP/NSTEMI and STEMI patients. Conclusions: UAP/NSTEMI and STEMI patients undergoing emergency PCI were at high risk for CI-AKI regardless of CV/eGFR ratio. Minimizing the dose of contrast medium based on eGFR might be valuable in reducing the risk of CI-AKI in SAP patients.
- 一般社団法人 日本循環器学会の論文
著者
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Takeyasu Noriyuki
Department of Cardiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba
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Aonuma Kazutaka
Cardiology Department Of Internal Medicine University Of Tsukuba Graduate School Of Comprehensive Hu
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Abe Daisuke
Department Of Cardiovascular Division Institute Of Clinical Medicine University Tsukuba
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Sato Akira
Cardiovascular Center Yokosuka Kyosai Hospital
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Watabe Hiroaki
Cardiovascular Division Institute Of Clinical Medicine Graduate School Of Comprehensive Human Sciences University Of Tsukuba
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Hoshi Tomoya
Cardiovascular Division, Faculty of Medicine, University of Tsukuba
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Kakefuda Yuki
Department of Cardiology, Tsukuba Medical Center Hospital
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Ojima Eiji
Cardiovascular Division, Faculty of Medicine, University of Tsukuba
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Hiraya Daigo
Cardiovascular Division, Faculty of Medicine, University of Tsukuba
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Harunari Tomohiko
Department of Cardiology, Tsukuba Medical Center Hospital
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Takeyasu Noriyuki
Department of Cardiology, Ibaraki Prefectural Central Hospital
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Abe Daisuke
Department of Cardiology, Ibaraki Prefectural Central Hospital
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