Abstract
Although many studies have demonstrated that CIN is associated with in-hospital and long-term mortality, the incidence of CIN following CAS is unclear. We investigated the incidence of CIN, defined as an increase from a baseline creatinine value of at least 0.5 mg/dL or 25% within 72 hours of contrast administration, and we also examined renal function in the late phase after CAS. We examined 80 patients who underwent CAS between April 2005 and December 2009. Clinical background, laboratory data, contrast volume, and clinical course were collected and analyzed. The incidence of CIN was 8.8% (7/80), and no patients required hemodialysis. In the group that developed CIN, prolonged CSR after CAS was found in 57.1% (4/7) of cases; this incidence differed significantly (P = .001) from that in the group without development of CIN. Neither preoperative renal function, contrast volume, nor history was related to the incidence of CIN, while on multivariate analysis, prolonged CSR was found to be an independent risk factor for CIN. The incidence of elevation in creatinine values at 6 months after CAS was 8.2% (6/73). All patients who developed delayed renal impairment had pre-existing CKD; this finding differed significantly (P = .04) from that in the group without development of delayed renal impairment. Because patients who develop prolonged CSR after CAS are at increased risk of perioperative major adverse clinical events including CIN, patients at high risk for this condition should be carefully managed to prevent increased morbidity and mortality.
Highlights
AND PURPOSE: many studies have demonstrated that CIN is associated with in-hospital and long-term mortality, the incidence of CIN following CAS is unclear
Contrast volume, nor history was related to the incidence of CIN, while on multivariate analysis, prolonged CSR was found to be an independent risk factor for CIN
Because the incidence of and risk factors for CIN and the change of SCr values at 6 months after CAS are unknown, we examined renal function in both the acute and late phases
Summary
We examined 80 patients who underwent CAS between April 2005 and December 2009. Background risk factors for CIN (age, history of hypertension, diabetes mellitus and CAD, use of diuretics, contrast volume, and re-administration of contrast agent within 72 hours) and preoperative SCr values were collected. Following CAS procedures, we collected SCr values within 72 hours as acute phase values and at 6 months after CAS as the late phase values. CAS was performed by using our standard procedure with the patient under local anesthesia. The standard CAS procedure involved the following: placement of a protective device, prestent angioplasty, placement with a selfexpandable type of stent, and poststent angioplasty. Prestent angioplasty was usually performed by using a 3.0 – 4.0 ϫ 30 – 40 mm angioplasty balloon and poststent angioplasty by using a 4.0 –5.0 ϫ 20 – 40 mm angioplasty balloon
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