Admission hyperglycemia and contrast induced nephropathy

Abstract

Aims: Admission hyperglycemia is a frequent condition in ST elevation myocardial infarction (STEMI) associated with an increased risk of contrast induced nephropathy (CIN)after primary percutaneous coronary intervention (pPCI). We evaluate the possible different role of acute and chronic hyperglycemia on CIN and the impact of its early spontaneous or pharmacologic normalization. Methods and results: 679 STEMI patients treated with pPCI were enrolled in our prospective study. CIN was defined as an absolute serum creatinine increase ≥0.3 mg/dl after procedure. Admission hyperglycemia was defined as glucose levels >198 mg/dl: acute or chronic increase was identified respectivelyin patients with a glycated haemoglobin A1c ≤7% and >7%.In hyperglicemic patients, a decrease of fasting glucose levels <140 mg/dl in second day was considered for early normalization. Admission hyperglycemia (17%) was an independent predictor for CIN incidence, but at subgroup analysis its prognostic impact emerged only in non diabetic patients. Similarly, only in this subgroup its rapid normalization was associated to a lower incidence of CIN and to a better outcome. Actually, CIN incidence was significantly higher in patients with acute hyperglycemia than in those with chronic hyperglycemia (34.5% vs 16.9%, p=0.03), irrespective of diabetes mellitus. Conclusions: Admission hyperglycemia relates to an increase risk of CIN, especially when it occurs acutely. A condition ofglycemic levels ≥198 mg/dl and glycated haemoglobin A1c ≤7%, identifies patients at higher risk, in whom a rapid glycemic control could become a further strategy of CIN prevention.