Abstract
BackgroundPost-contrast acute kidney injury (PC-AKI) is a severe complication of coronary angiography (CAG) and percutaneous coronary intervention (PCI). Currently, the effect of statins on PC-AKI and its mechanism remains unclear.MethodsThis multicenter retrospective observational study included 4386 patients who underwent CAG or PCI from December 2006 to December 2019 in Sir Run Run Shaw Hospital and its medical consortium hospitals. Serum creatinine pre- or post-procedure within 72 h after PCI was recorded. Multivariate logical regression was used to explore whether preoperative use of statins was protective from PC-AKI. The path analysis model was then utilized to look for the mediation factors of statins.ResultsFour thousand three hundred eighty-six patients were enrolled totally. The median age of the study population was 68 years old, 17.9% with PC-AKI, and 83.3% on preoperative statins therapy. The incidence of PC-AKI was significantly lower in group of patients on statins therapy. Multivariate regression indicated that preoperative statins therapy was significantly associated with lower percentage of elevated creatinine (β: -0.118, P < 0.001) and less PC-AKI (OR: 0.575, P < 0.001). In the preoperative statins therapy group, no statistically significant difference was detected between the atorvastatin and rosuvastatin groups (OR: 1.052, P = 0.558). Pathway model analysis indicated a direct protective effect of preoperative statins therapy on PC-AKI (P < 0.001), but not through its lipid-lowering effect (P = 0.277) nor anti-inflammatory effect (P = 0.596). Furthermore, it was found that “low-density lipoprotein cholesterol (LDL-C)→C-reactive protein (CRP)” mediated the relationship between preoperative statins therapy and PC-AKI (P = 0.007). However, this only explained less than 1% of the preoperative protective effects of statins on PC-AKI.ConclusionPreoperative statins therapy is an independent protective factor of PC-AKI, regardless of its type. This protective effect is not achieved by lipid-lowering effect or anti-inflammatory effect. These findings underscore the potential use of statins in preventing PC-AKI among those at risk.
Highlights
Post-contrast acute kidney injury (PC-AKI), defined as “an increase in serum creatinine ≥ 0.3mg/dl (26.5μmol/ l), or ≥ 1.5 times the baseline value within 48–72h of exposure to a contrast medium (CM)” [1, 2], accounts for up to 30% of acute kidney injury in hospitalized patients [3]
There were no significant differences between the groups in smoking status, hypertension, uric acid, low-density lipoprotein cholesterol (LDL-C), angiotensin converting enzyme inhibitors (ACEI), diuretic, ezetimibe, aspirin, type and volume of CM, history of myocardial infarction and cardiac surgery, type of operation, multi vessel percutaneous coronary intervention (PCI) and total length of stents
The results showed that preoperative statins therapy was significantly negatively associated with PC-AKI (β = −.0.085, P < 0.001) and LDL-C had no significant effect on PC-AKI (P = 0.311)
Summary
Post-contrast acute kidney injury (PC-AKI), defined as “an increase in serum creatinine ≥ 0.3mg/dl (26.5μmol/ l), or ≥ 1.5 times the baseline value within 48–72h of exposure to a contrast medium (CM)” [1, 2], accounts for up to 30% of acute kidney injury in hospitalized patients [3]. There is no consensus among experts on the usefulness of pretreatment with statins This is despite the 2014 European Society of Cardiology’s guidelines which stated that shortterm and high-intensity statins therapy reduces the risk of PC-AKI in patients undergoing myocardial revascularization [5]. While some studies have reported a reduction in PC-AKI events among statins users [6,7,8,9,10], others did not show such benefit [11,12,13,14,15], and one study even demonstrated more PC-AKI outcomes with statins [13] Given these contradicting results, current PC-AKI guidelines do not recommend statins. The effect of statins on PC-AKI and its mechanism remains unclear
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