Abstract 13780: Aggressive Hydration and Contrast-Induced Acute Kidney Injury Following Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: A Randomized Controlled Study

Abstract

Objective: To evaluate the efficacy of aggressive hydration compared with general hydration for contrast induced acute kidney injury (CI-AKI) prevention among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Methods: The ATTEMPT study is an open-label, randomized controlled study at 15 teaching hospitals in China. A total of 560 adult patients were randomly assigned (1:1) to receive aggressive hydration or general hydration treatment. Aggressive hydration group received preprocedural loading dose of 125/250 mL normal saline within 30 minutes, followed by postprocedural hydration performed for 4 hours under left ventricular end-diastolic pressure guidance and additional hydration until 24 hours after pPCI. General hydration group received ≤500 mL 0.9% saline at 1 mL/kg/h for 6 hours after randomization. The primary endpoint is CI-AKI, defined as a >25% or 0.5 mg/dL increased in serum creatinine from baseline during the first 48-72 hours after primary angioplasty. The safety endpoint is hydration relative acute heart failure. Results: From July 2014 and May 2018, 469 patients were enrolled in the final analysis. CI-AKI occurred less frequently in aggressive hydration group than in general hydration group (21.8% vs. 31.1%; RR 0.78, 95% CI 0.61 to 0.98). Hydration relative acute heart failure did not significantly differ between the aggressive hydration group and the general hydration group (7.9% vs. 6.9%, RR 1.07, 95% CI 0.77 to 1.48). Several subgroup analysis showed the better effect of aggressive hydration in CI-AKI prevention in male, renal insufficient and non-anterior myocardial infarction participants. Conclusions: Comparing with general hydration, the peri-operative aggressive hydration seems to be safe and effective in preventing CI-AKI among patients with STEMI undergoing pPCI.