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KMID : 0882420120820020185
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Korean Journal of Medicine
2012 Volume.82 No. 2 p.185 ~ p.193
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Predictors of Contrast-Induced Nephropathy in Acute Coronary Syndrome Patients with Renal Dysfunction
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Park Soo-Hwan
Jeong Myung-Ho
Rhee Jung-Ae
Choi Jin-Su
Hwang Seung-Hwang
Ko Jum-Suk
Lee Min-Goo
Sim Doo-Sun
Park Keun-Ho
Yoon Nam-Sik
Yoon Hyun-Ju
Kim Kye-Hun
Hong Young-Joon
Kim Ju-Han
Ahn Young-Keun
Cho Jeong-Gwan
Park Jong-Chun
Kang Jung-Chaee
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Abstract
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Backgrounds/Aims:Contrast-induced nephropathy (CIN) is an important complication of diagnostic coronary angiography (CAG) and percutaneous coronary intervention (PCI). We investigated the incidence and predictors of the development of CIN in acute coronary syndrome (ACS) patients with renal dysfunction undergoing PCI.
Methods:From January 2005 to June 2010, we evaluated the clinical, laboratory, and angiographic data of 406 patients with ACS who had a serum creatinine ≥ 1.3 mg/dL and underwent CAG or PCI. The patients were divided into two groups according to the development of CIN (CIN, n = 92; no CIN, n = 314).
Results:Of the 406 patients, 92 (22.7%) developed CIN. The development of CIN was associated with a lower baseline body mass index (p = 0.001), decreased left ventricular ejection fraction (LVEF) (p < 0.001), decreased creatinine clearance (CrCl) (p < 0.001), lower albumin (p < 0.001), lower hemoglobin (p = 0.003), higher N-terminal pro B type natriuretic peptide (p = 0.001), and greater contrast medium volume (CMV) (p = 0.021). On multiple logistic regression analysis, LVEF < 40% (OR, 4.080; 95% CI, 2.087-7.977; p < 0.001), albumin < 3.5 g/dL (OR, 2.042; 95% CI, 1.211-3.440; p = 0.007), and CMV/CrCl ≥ 3.5 (OR, 1.964; 95% CI, 1.243-3.101; p = 0.004) were independent predictors of CIN. The cut-off value for CMV/CrCl was 3.5, and that for albumin was 3.55 g/dL.
Conslusions:CIN occurred in 22.7% of the patients with ACS and renal dysfunction who underwent CAG or PCI. Independent predictors of CIN were decreased LVEF, decreased albumin, and increased CMV/CrCl ratio.
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KEYWORD
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Contrast-induced nephropathy, Acute coronary syndrome, Renal dysfunction
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