Effects of intravenous hydration on risk of contrast induced nephropathy and in-hospital mortality in STEMI patients undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials

Yong Liu,Amanda Ying Wang,Jin Liu,Ahmed Shaman,Shariful Islam,Martin Gallagher,Ning Tan,Brendan Smyth,Guoli Sun,Shiqun Chen,Jiyan Chen,Rui Guo,Daqing Hong,David Brieger,Meg Jardine

doi:10.1186/s12872-019-1054-y

Abstract

BackgroundThe role of intravenous hydration at the time of primary percutaneous intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains unclear. Guidelines are vague, supported by low level evidence, and hydration is used less often than other clinical settings.To perform a systematic review and meta-analysis of all randomized controlled trials assessing intravenous hydration compared with non-hydration for prevention of contrast induced nephropathy (CIN) and In-hospital mortality in patients with STEMI undergoing primary PCI.MethodsMedline, EMBASE and the Cochrane Register were searched to September 2018. Included studies reported the incidence of CIN, In-hospital mortality, requirement for dialysis and heart failure. Relative risks with 95% confidence intervals (CIs) for individual trials were pooled using a random effects model.ResultsThree moderate quality trials were identified including 1074 patients. Overall, compared with no hydration, intravenous hydration significantly reduced the incidence of CIN by 42% (RR 0.58; 95% CI: 0.45 to 0.74, p < 0.001). The estimated effects upon all-cause mortality (RR 0.56; 95% CI: 0.30 to 1.02, p = 0.057) and the requirement for dialysis (RR 0.52, 95% CI 0.14–1.88, p = 0.462) were not statistically significant. The outcome of heart failure was not consistently reported.ConclusionsIntravenous hydration likely reduces the incidence of CIN in patients with STEMI undergoing primary PCI. However, for key clinical outcomes such as mortality, heart failure and dialysis the effect estimates were imprecise. Further high quality studies are needed to clarify the appropriate volume of fluid and effects on outcomes.

Highlights

The role of intravenous hydration at the time of primary percutaneous intervention (PCI) for STsegment elevation myocardial infarction (STEMI) remains unclear
Intravenous hydration likely reduces the incidence of contrast induced nephropathy (CIN) in patients with STEMI undergoing primary PCI
Study characteristics Three randomized controlled trials (RCT) were selected for the review and meta-analysis all of which reported the incidence of CIN as defined above

Summary

Introduction

The role of intravenous hydration at the time of primary percutaneous intervention (PCI) for STsegment elevation myocardial infarction (STEMI) remains unclear. Guidelines are vague, supported by low level evidence, and hydration is used less often than other clinical settings.To perform a systematic review and metaanalysis of all randomized controlled trials assessing intravenous hydration compared with non-hydration for prevention of contrast induced nephropathy (CIN) and In-hospital mortality in patients with STEMI undergoing primary PCI. One recent study using intravenous hydration with normal saline before radiocontrast exposure, the cornerstone of CIN prevention across clinical medicine, showed a renal benefit for patients with STEMI [4]. Such therapy is less commonly used in patients undergoing primary PCI compared to elective PCI [5], probably due to the urgency of the procedure and concern about the development of congestive heart failure [6]. Clinical guidelines for PCI management recommend ‘adequate preparatory hydration’ [7], supported by lower level evidence, and more recent STEMI guidelines do not contain graded recommendations regarding the use of prophylactic hydration [8]

Methods

Results

Discussion

Conclusion