Two Clinical Observations Of Contrast-induced Acute Kidney Injury In Patients With Coronary Heart Disease

Objective1.To observe the effect of atorvastatin about contrast-induced acute kidney injury in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.2.Comparison of the incidences of contrast-induced acute kidney injury between low-osmolar and iso-osmolar contrast medium in patients undergoing coronary angiography with or without percutaneous coronary intervention.Methods Research1:A total of282patients admitted in General Hospital of Tianjin medical university with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention were randomized to receive either high dose group (atorvastatin80mg, n=143) or routine dose group (atorvastatin20mg, n=139). Research2:A totel of885patients undergoing selective coronary angiography and/or percutaneous coronary intervention were randomized to receive either low-osmolar contrast medium iopromide (n=441) or iso-osmolar contrast medium iodixanol (n=444). Exclude criteria:acute and chronic renal failure(eGFR<30ml/min/1.73m2), renal transplant, end-stage renal disease requiring dialysis, infectious diseases, autoimmune diseases, a history of hepatic dysfunction, pregnancy, multiple myeloma, hyperthyroidism, history of hypersensitivity to contrast media, previous contrastmedia exposure and statin treatment within7day, patients not suited for percutaneous coronary intervention and need emergency coronary artery bypass grafting after coronary arteriography were excluded from the present study. All patients received intravenous saline hydration. All the patients accepted routine medicine treatment as aspirin, clopidogrel, nitrates, low molecular weight heparin, ACEI/ARB class drugs, β receptor blockers and other drugs before and after PCI. Serum creatinine was measured before admission of PCI, and24,48,72hours and7day after PCI. The creatinine clearance was calculated using the Cockcroft-Gault formula. The estimated glomerular filtration rate was calculated using the Modified Glomerular Filtration Rate Estimating Equation for Chinese Patients. The primary study end point was the incidence of contrast-induced acute kidney injury, which was defined as an absolute increase in serum creatinine≥0.5mg/dl (44.2umol/L) or a relative increase≥25%compared to baseline SCr. And the comparision with maximal rangeability in SCr, CCr and eGFR between two groups. The second study end point was the risk factors and predictors of the contrast-induced acute kidney injury.Results1. The patients clinical baseline data(age, gender, body mass index, smoking, hyperlipidemia, diabetes, anterior myocardial infarction, total cholesterol, low density lipoprotein cholesterol-C, serum creatinine, peak CK, left ventrieular ejection fraction, drugs use)between the two groups of research1were no significant different, also two groups of research2(p>0.05).2. Research1:total of58patients occurred contrast-induced acute kidney injury (20.6%),19in the high dose group and39in the routine group(13.3%vs.28.1%, p=0.003). The maximal rangeability in SCr, CCr and eGFR between high dose group and routine group were different(p<0.05). At24h,48h and72h, the SCr in high dose group were lower than routine dose group, and the CCr and eGFR in high dose group were higher than routine dose group(p<0.05).3. Research2:total of56patients occurred contrast-induced acute kidney injury (20.6%),27in the iopromide group and29in the iodixanol group (6.1%vs6.5%, p=0.803). The maximal rangeability in SCr, CCr and eGFR between iopromide group and iodixanol group were not different(p>0.05). At24h,48h and72h, the SCr, CCr and eGFR between two groups had no statistically significant differences.4. Research1:multivariable logistic analysis showed that left ventrieular ejection fraction (LVEF)<0.40was a predictor of CI-AKI.(odds ratios2.47,95%confidence interval1.17to5.16, p=0.02).5. Research2:multivariable logistic analysis showed that left ventrieular ejection fraction (LVEF)<0.40was associated with a decreased risk of CI-AKI (odds ratios2.99,95%confidence interval1.21to7.42, p=0.018).Conclusion1.Treatment with high dose atorvastatin before primary percutaneous coronary intervention could further decrease the incidence of contrast-induced acute kidney injury compared with routine dose group.2. The incidence of contrast-induced acute kidney injury did not significantly differ between the iopromide and iodixanol groups.3.Left ventricular dysfunction (Left ventrieular ejection fraction<0.40) is a predictor of contrast-induced acute kidney injury.