Impact of very high doses of contrast media on acute kidney injury rates in patients admitted with ST-elevation myocardial infarctions

Abstract

Abstract Introduction Previous studies have shown that in patients with ST-elevation myocardial infarctions (STEMI) maybe the main contributor of acute kidney injury (AKI) is the STEMI itself with its hemodynamic sequelae and to a lesser extent contrast media induced nephropathy (CIN). However, the possible impact of very high doses of contrast media (CM) on kidney function in this context remains unclear. Aim of the present study was therefore to investigate, how very high doses of CM influenced AKI-rates in patients admitted with STEMI. Methods Patients admitted with STEMI between 2006 and 2022 to a large German heart center entered analysis. A very high dose of contrast media was defined as >250 ml. AKI was defined by KDIGO-criteria (2012). To minimize impact of confounders patients were grouped by initial TIMI-risk-score and initial renal function (glomerular filtration rate (GFR)) in a 3x3 format. Results Of a total of 8845 patients included, 547 patients (6.2%) received a CM-dose >250 ml with an average CM-amount of 318.2±64 ml vs. 135.8±48 ml in the control group. A multivariate model revealed that patients receiving very high CM-doses were more likely to be older (OR 1.31, 95% CI 1.1-1.6, p<0.01) and to have more extensive STEMIs (CK>2000 U/ml: OR 1.33, 95% CI 1.1-1.6), while they were less likely to be female (0.77, 95% CI 0.6-0.9,p=0.01) and less likely to have undergone successful percutaneous coronary intervention (PCI): OR 0.51, 95% CI 0.4-0.6, p<0.01. Patients receiving very high doses of CM were more likely to develop AKI: 21.6% vs. 14.9,%, p<0.01. This significant impact remained after adjusting in a multivariate model (OR 1.42 95% CI 1.1-1.9, p<0.01). When stratifying patients into nine groups (3x3) both, initial TIMI-risk-score for STEMI and a lower GFR were associated with a marked increase in AKI-rates, with the lowest AKI-rate at 3.4% in patients with a low TIMI-risk and an initial GFR of 60-89 ml/min and the highest AKI rate at 37.8% in patients with a high TIMI-risk score and a GFR<60 ml/min (table (A)). However, the impact of very high CM-amounts on AKI-rates in this pre-stratified cohorts was inconsistent and only independently associated with a higher AKI-risk in 1 out of 9 groups (marked by astrisk*, table (B)). Conclusions STEMI-Patients receiving very high amounts of contrast media during emergency cardiac catheterization were on average older with larger infarctions and showed lower rates of successful percutaneous coronary interventions (PCI). For the majority of these patients even very high amounts of contrast media were not independently associated with higher rates of acute kidney injury. AKI-rates were more likely to be determined by overall risk and initial renal function.