Abstract
Background: Previous studies have shown that contrast-induced nephropathy (CIN) defined in several ways is associated with poor outcomes. However, there is no consensus on the optimal definition of CIN. Objective: We examined the prognostic significance of 3 contemporary definitions of CIN with respect to long-term major adverse cardiac and cerebrovascular event (MACCE) and mortality after emergency coronary angiography for acute myocardial infarction (AMI). Methods: We measured serum creatinine (SCr) at admission and each day for the following 3 days in 733 patients with AMI who underwent emergency coronary angiography within 12 h after symptom onset. CIN was defined as SCr increase ≥0.5 mg/dl, SCr increase ≥25%, or estimated glomerular filtration rate (eGFR) decrease ≥25%. Results: Of 733 patients (age 64 ± 12 years), 47% were anterior AMI, 31% had renal dysfunction defined as admission eGFR <60 ml/min/1.73m2, and 81% underwent primary percutaneous coronary intervention. The mean volume of contrast medium used was 155 ± 57 ml. The incidence of CIN ranged widely depending on the definition used; 7.8% (SCr increase ≥0.5 mg/dl), 37.4% (SCr increase ≥ 25%), and 29.2% (eGFR decrease ≥ 25%). There were significant differences of 5-year MACCE (all-cause death, non-fatal myocardial infarction, or stroke) and all-cause mortality between patients with and without CIN by the 3 definitions (especially SCr increase ≥0.5 mg/dl). In multivariate analysis, only SCr increase ≥0.5 mg/dl was independently and significantly associated with 5-year MACCE and all-cause mortality; but the other 2 definitions were not. Conclusions: In patients with AMI undergoing emergency coronary angiography, of the 3 contemporary definitions of CIN, only SCr increase ≥0.5 mg/dl strongly predicts 5-year adverse outcomes, suggesting the prognostic importance of this definition.
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