Low Ejection Fraction Predisposes to Contrast-Induced Nephropathy after the Second Step of Staged Coronary Revascularization for Acute Myocardial Infarction: A Retrospective Observational Study.

Michał Chyrchel,Monika Gębska,Andrzej Surdacki,Olgerd Duchnevič,Przemysław Hałubiec,Michał Okarski,Agnieszka Łazarczyk

doi:10.3390/jcm9061812

Michał Chyrchel, Monika Gębska + Show 5 more

Open Access

https://doi.org/10.3390/jcm9061812

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Abstract

Patients who develop contrast-induced nephropathy (CIN) are at an increased short-term and long-term risk of adverse cardiovascular (CV) events. Our aim was to search for patient characteristics associated with changes in serum creatinine and CIN incidence after each step of two-stage coronary revascularization in patients with acute myocardial infarction (AMI) and multivessel coronary artery disease undergoing staged coronary angioplasty during hospitalization for AMI. We retrospectively analyzed medical records of 138 patients with acute myocardial infarction without hemodynamic instability, in whom two-stage coronary angioplasty was performed during the initial hospital stay. In-hospital serum creatinine levels were recorded before the 1st intervention (at admission), within 72 h after the 1st intervention (before the 2nd intervention), and within 72 h after the 2nd intervention. The incidence of CIN was 2% after the 1st intervention (i.e., primary angioplasty) and 8% after the 2nd intervention. Patients with significant left ventricular systolic dysfunction after the 1st intervention (ejection fraction (EF) ≤35%) exhibited higher relative rises in creatinine levels after the 2nd intervention (18 ± 29% vs. 2 ± 16% for EF ≤35% and >35%, respectively, p = 0.03), while respective creatinine changes after the 1st revascularization procedure were comparable (−1 ± 14% vs. 2 ± 13%, p = 0.4). CIN after the 2nd intervention was over five-fold more frequent in subjects with low EF (28% vs. 5%, p = 0.007). The association between low EF and CIN incidence or relative creatinine changes after the 2nd intervention was maintained upon adjustment for baseline renal function, major CV risk factors, and the use of renin-angiotensin axis antagonists prior to admission. In conclusion, low EF predisposes to CIN after second contrast exposure in patients undergoing two-stage coronary angioplasty during the initial hospitalization for AMI. Our findings suggest a need of extended preventive measures against CIN or even postponement of second coronary intervention in patients with significant left ventricular dysfunction scheduled for the second step of staged angioplasty.

Highlights

According to current clinical practice guidelines, complete coronary revascularization should be considered before discharge in patients with acute myocardial infarction (AMI) and multivessel coronary artery disease (CAD) [1,2]
Our aim was to search for patient characteristics associated with changes in serum creatinine and contrast-induced nephropathy (CIN) after each procedural session in AMI patients treated with staged multivessel coronary angioplasty
In patients who developed CIN after the 2nd intervention, the proportion of subjects with an ejection fraction (EF) ≤35% was significantly higher compared to their counterparts without this complication (50% vs. 12%, p = 0.007; Table 1)

Summary

Introduction

According to current clinical practice guidelines, complete coronary revascularization should be considered before discharge in patients with acute myocardial infarction (AMI) and multivessel coronary artery disease (CAD) [1,2]. Most evidence supports benefits of multivessel angioplasty (as either a one-time or staged intervention) compared to culprit lesion-only intervention, which is primarily linked to a decreased need of urgent revascularization and to beneficial trends in other clinical endpoints [2,3,4,5,6]. There are no firm recommendations on the optimal timing of non-culprit lesion angioplasty or inter-procedural intervals in staged interventions [2]. The choice between these alternative approaches remains at the operator’s discretion and depends on multiple periprocedural and non-procedural issues affecting the net balance between individual clinical benefits and risks for each of the alternative management strategies. Early identification of AMI subjects at high risk of CIN is necessary to optimize preventive measures in order to reduce CIN incidence and improve outcome

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