Abstract
As the incidence of diabetes and cardiovascular comorbidities continues to rise, driven by increased prevalence of obesity and an aging population, so does the demand for percutaneous coronary intervention (PCI) to restore cardiac blood flow. Renin-angiotensin-aldosterone system (RAAS) inhibitors are commonly prescribed to hypertensive diabetic patients to prevent diabetic nephropathy. However, evidence suggests that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase the risk of contrast-induced acute kidney injury (CIAKI) following coronary angiography (CAG) and PCI. We therefore conducted a retrospective, multicenter study applying the propensity score matching method to evaluate the impact of RAAS inhibition on CIAKI in diabetic patients undergoing CAG/PCI. Among 2240 subjects that met the inclusion criteria, 704 patients in the ACEIs/ARBs group were successfully matched to eligible control patients. The incidence of CIAKI (serum creatinine increase ≥0.5 mg/dl or ≥25% from baseline within 72 h post-CAG/PCI) was significantly higher in the ACEIs/ARBs group than in the control group (26.6% vs. 16.2%, P<0.001). However, control patients showed increased risk of overall adverse cardiovascular events (4.1% vs. 1.8% for ACEIs/ARBs; P=0.016). These data indicate that RAAS inhibition increases the risk of CIAKI in diabetic patients, but confers protection against early cardiovascular events.
Highlights
The incidence of diabetes and coronary heart disease continues to rise as a result of the current obesity epidemics and an increasingly aging population worldwide
The prevalence of hypertension, proteinuria, unstable angina, multi-vessel disease, and use of β-blockers, oral hypoglycemic agents, and diuretics was higher in patients receiving angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) compared with controls
Prevalence of hypertension, chronic kidney disease (CKD), acute myocardial infarction (AMI), prior myocardial infarction, unstable angina, multi-vessel disease, β-blockers, diuretics, calcium channel blockers (CCB), oral hypoglycemic agents, and proteinuria were higher in the ACEI/ARB group
Summary
The incidence of diabetes and coronary heart disease continues to rise as a result of the current obesity epidemics and an increasingly aging population worldwide. Contrast-induced acute kidney injury (CIAKI) is a common complication after PCI, and is associated with significant short- and longterm morbidity and mortality [3]. CIAKI occurs in less than 3% of patients undergoing PCI, whereas in www.aging-us.com higher-risk populations such as those with diabetes or renal failure, the incidence can be as high as 50% [5]. Diabetes is one of the most important and common risk factors for CIAKI [6]. In diabetic patients complications develop 3 times faster than in those without the disease [7], and CIAKI-related mortality rates can be as high as 30% [8]
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