SP196INCIDENCE, RISK FACTORS AND PROGNOSTIC VALUE OF CONTRAST-INDUCED ACUTE KIDNEY INJURY IN PATIENTS WITH DELAYED PERCUTANEOUS CORONARY INTERVENTION

Abstract

Objective: Contrast-induced acute kidney injury (CI-AKI) is a well-known serious complication of percutaneous coronary intervention (PCI) associated with increased morbidity and mortality. The aim of the study was to evaluate the incidence, predictors and outcomes of CI-AKI in patients with unstable angina pectoris/non-ST-segment elevation myocardial infarction (UAP/NSTEMI) and delayed PCI. Methods: 236 patients with UAP/NSTEMI and delayed PCI (158 male, 69+/-14 years (M+/-SD), arterial hypertension 94%, previous MI 36%, diabetes mellitus (DM) 22%, known chronic kidney disease 15%, anemia 15%, heart failure 58%, left ventricular ejection fraction 44+/-6%) were examined. CI-AKI was defined using 2012 KDIGO Guidelines. Mann-Whitney test and multivariate logistic regression analysis were performed. P <0.05 was considered statistically significant. Results: 15% of patients developed CI-AKI. Stages 1 and 2 of CI-AKI were found in 71 and 29% of cases accordingly. CI-AKI developed in 61% of cases in first 48 hours after PCI. Patients with versus without CI-AKI had higher baseline serum creatinine (104+/-32 vs 98+/-24 mumol/l, p<0.05), plasma glucose (8.4+/-3.9 vs 6.7+/-2.7 mmol/l, p<0.05), higher rate of DM (39 vs 19.5%, p<0.05), anemia (28 vs 12.5%, p<0.05), stroke (44 vs 20%, p<0.05), higher rate of therapy with nephrotoxic antibiotics (11 vs 3.5%, p<0.05), lower rate of postprocedural TIMI3 (83 vs 96 %, p<0.05), higher rate of main left coronary artery disease (59 vs 30%, p<0.001). Main independent predictors of CI-AKI were main left coronary artery disease (odds ratio (OR) 4.45; 95% confidence interval (CI) 1.89-10.50; p<0.001), therapy with nephrotoxic antibiotics (OR 4.04; 95% CI 1.08-15.12; p<0.05), stroke (OR 3.20; 95% CI 1.52-6.73; p<0.05), anemia (OR 2.69; 95% CI 1.16-6.24; p<0.05), DM (OR 2.63; 95% CI 1.23-5.59; p<0.05). Patients with CI-AKI had higher risk of hospital mortality (11 vs 1.5%, p<0.001), 30-days mortality (12 vs 4%, p<0.05) and similar rate of 6 months rehospitalizations (74 vs 58%, p>0.05). Conclusions: CI-AKI in patients with UAP/NSTEMI and delayed PCI developed in 15% of cases, predominantly in first 48 hours after PCI. CI-AKI was associated with higher rate of comorbidities (DM, anemia, stroke), therapy with nephrotoxic drugs, higher baseline serum creatinine and plasma glucose, main left coronary artery disease, lower rate of postprocedural TIMI3. CI-AKI had negative impact on hospital mortality, 30-days mortality.