Radiocontrast-Induced Acute Kidney Injury Following Coronary Angiography and Percutaneous Coronary Intervention: A Retrospective Cohort Study

Van Bui Pham ,Quang Dung Nguyen ,Nghia Huynh Thi Nguyen ,Thành Liêm Võ ,Thanh Phuong Pham Nguyen ,M Duong

doi:10.11648/j.ajim.20180605.18

Abstract

Despite the remarkable technological advances in coronary angiography (CA)/percutaneous coronary intervention (PCI) for diagnosis and treatment of coronary artery disease, the contrast-induced acute kidney injury (CI-AKI) is always an important cause of hospital-acquired AKI. Most local CI-AKI studies in Vietnam had small sample sizes and short-term follow-up of only 24-48 hours following CA or PCI intervention, resulting in controversial conclusions. We conducted a study of the incidence of CI-AKI during a longer follow-up time period and associated risk factors among adult patients undergoing CA/ PCI at Nguyen Tri Phuong University Public Hospital and Tam Duc Private Cardiology Center in Ho Chi Minh City, Vietnam between January 2014 and March 2015. All 320 patients with CA/PCI at the two hospitals were enrolled in a retrospective cohort study. Information on demographic data, treatment, and laboratory test results was collected from the patients’ records. The total cumulative incidence of CI-AKI at 24, 48, 72 and ≥72 hours following CA/PCI was 6.7%, 12%, 14% and 16.9% respectively. Prognostic factors for CI-AKI included an increase by 1 ml/min/1,73m² in clearance creatinine before the intervention (P = 0.006, Hazard Ratio (HR) = 0.970, 95%CI 0.949 – 0.991) and an increase by 1% in ejection fraction (P = 0.023, HR = 0.984, 95%CI 0.970 – 0.998). Delayed CI-AKI was not rare after CA/PCI intervention. Therefore, it is pivotal to monitor serum creatinine in a longer time after the intervention to timely detect CI-AKI. Also, information on risk factors such as emergency interventions, chronic kidney disease, and ejection fraction < 45% could assist in predicting CI-AKI development.

Highlights

Coronary angiography (CA) has been the gold standard for the diagnosis of coronary artery disease (CAD) which is one of the most common causes of death [1]
We found that the total cumulative incidence of contrast-induced acute kidney injury (CI-acute kidney injury (AKI)) at 24, 48, 72 and >72 hours following CA/percutaneous coronary intervention (PCI) was 6.7%, 12%, 14%, and 16.9%, respectively among our study participants whose serum creatinine was measured at these time points
There was no difference in the rate of coronary intervention (CI)-AKI found among four kinds of radiocontrast used in our study

Summary

Introduction

Coronary angiography (CA) has been the gold standard for the diagnosis of coronary artery disease (CAD) which is one of the most common causes of death [1]. Coronary Intervention: A Retrospective Cohort Study studies, contrast-induced acute kidney injury (CI-AKI) is the third most common cause of hospital-acquired AKI [2,3,4]. This condition results in a permanent loss of kidney function and an increased mortality rate among in-hospital patients [5, 6]. Risk factors for CI-AKI include high-dose radiocontrast, chronic kidney disease (CKD), diabetes mellitus (DM), old age, severe heart failure (HF), peri-interventional cardiovascular instability, coadministration of nephrotoxic drugs, dyslipidemia, hypertension (HT) and anemia [9,10,11,12]. A careful assessment and detection of these factors are crucial in preventing CIAKI, and thereby improving the efficacy of coronary intervention and patient’s outcome

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