Aggressive therapy to prevent contrast-induced kidney damage during percutaneous coronary interventions

Abstract

Abstract Introduction In the era of the development of medical technology percutaneous coronary intervention (PCI) has become the most common method of surgical treatment of coronary arteries in patients with coronary heart disease (CHD). Contrast-induced nephropathy (CIN) is a harbinger of chronic renal failure. The recommendations for myocardial revascularization for the prevention of CIN recommend the use of statin treatment. The choice of the optimal statin, the duration of its administration and the effectiveness of loading doses of statins in preventing CIN still remain unresolved topical issues. The purpose of research work: 1) to evaluate the effectiveness of the prevention of contrast-induced kidney damage when using a loading dose of statins; 2) to study the possibility of early diagnosis of renal damage by examining serum creatinine levels, calculating the glomerular filtration rate (GFR) and the index of a new biomarker of cystatin C. Material and methods All patients with CHD, hemodynamically significant stenosis of the coronary arteries were sent to elective endovascular myocardial revascularization. All patients underwent: general clinical examination, a serial study of biochemical blood analysis parameters: creatinine, c-reactive protein (CRP), cystatin C level, GFR. Using the envelope method, the patients were divided into two groups. Patients of the first group were prescribed atorvastatin at a dose of 80 mg for 7 days: 3 days before PCI and 4 days after it. The second group included patients who were treated with rosuvastatin at a dose of 40 mg for 7 days: 3 days before PCI and 4 days after PCI. Conclusion The incidence of CI AKI in patients with planned PCI during the administration of high doses of rosuvastatin was less frequent compared with loading therapy with atorvastatin, respectively 3.33% and 12.12%. On average, an increase in the concentration of serum creatinine to the maximum level in patients receiving atorvastatin was higher than in the second group with loading therapy of rosuvastatin (14.3% versus 8.1%, p=0.024). The decrease in GFR calculated by the formula CKD-Epi was detected 48 and 72 hours after PCI. At the same time, a study of plasma cystatin C showed a decrease in renal function 12 and 24 hours after surgery with the introduction of a contrast agent. This biomarker is an effective marker for early detection of renal failure, even with normal creatinine levels. The anti-inflammatory effect was evaluated by a highly sensitive CRP. In patients with CHD after PCI during therapy with rosuvastatin it was significantly stronger compared with the group of patients using atorvastatin. Thus, the use of rosuvastatin in order to prevent CI of AKI during CPI in patients with CHD seems to be preferable in comparison with atorvastatin due to a more pronounced nephroprotective and anti-inflammatory effect. Aggressive statin therapy Funding Acknowledgement Type of funding source: None