The Correlation Study Between Acute Hyperglycemia And Contrast-induced Nephropathy In Paitents Undergoing Primary Percutaneous Coronary Intervention

Background and Objective: With the developing of people’s living standard，The incidence of coronary heart disease gradually increased, and has bacame one ofthe principal diseases menacing human health. In recent years, with the continuousdevelopment and improvement of percutaneous coronary interventional, the effect hadbeen greatly improved, not only enormously improved the quality of patient’s life, butalso significantly reduce the morbidity and mortality of myocardial infarction inhigh-risk patients. But at the same time interventional therapy also has somelimitations, one of them is the contrast-induced nephropathy, the iatrogenic injury hasrisen to the third reason of acquired renal injury in hospital, about12%of the totlecacaes. In the treamtment of patients of acute myocardial infraction, percutaneouscoronary intervention is an effective method of reperfusion therapy, which caneffectively alleviate the symptoms, improve the prognosis, and save the lives ofpatients. CIN is a common complication after PCI, the incidence of CIN is between9.6-19%in acute myocardial infarction patients with stable hemodynamic, and can beincreased up to50%in patinets with cardiogenic shock. Therefore, positively researchthe risk factor associated with CIN which easy to be ignored has importantsignificance. Studies have shown that there is obvious correlation betweenpreoperative acute hyperglycemia and the incidence of CIN in patients undergoingemergency coronary artery interventional therapy, especially in patients withoutDiabetes mellitus previously, its predictive utility become better. The research isaimed at explicit the relevance between preoperative acute hyperglycemia and theincidence of CIN in patients undergoing emergency coronary artery interventionaltherapy by comparing the incidence of the acute hyperglycemia group and non-acutehyperglycemia group.Research Methods: The research select195patients with acute ST segmentelevation myocardial infarction which treated with emergency percutaneous coronary intervention in department of cardiology, China-Japan Union Hospital of JilinUniversity from January2013to July2014. These patients are divided into acutehyperglycemia group and non acute hyperglycemia group according to the admissionblood glucose, and recorded the general situation consist of gender、age、weight、admission blood glucose、admission serum creatinine、admission eGFR、reperfusiontime、postoperative LVEF、volume of contrast agent, whether the patients sufferedfrom hypertension or diabetes mellitus, whether there is a history of smoking、PCI orCABG, whether is the anterior myocardial infarction and so on. Then determine thelevel of serum creatinine and eGFR within48hours after operation and comparewhether there is statistically significant of the incidence of CIN between two groups.All statistical analysis adopt SPSS18.0Chinese version statistics software package foranalysis. Normal distribution test use the Kolmogorov-Smirnov test, Continuousvariables according with normal distribution are presented as mean±SD and werecompared using the t test for independent samples. Variables not normally distributedare presented as median and interquartile ranges, and were compared with theWilcoxon rank sum test. Categorical data are presented as rate or percentage and werecompared using the χ2test or the Fisher exact test, as appropriate. MultivariateLogisitic regression analysis was used to estimate the relevance between acutehyperglycemia and the incidence of CIN after emergency percutaneous coronaryinterventional therapy. P <0.05was considered statistically significant.Research Results: A total of195consecutive patients were included in this study.Of them,44had acute hyperglycemia and151had non acute hyperglycemia.24patients had CIN. The result of Chi square test showed that the incidence of CIN ofthe acute hyperglycemia group is higher that the other group（25.0%VS8.6%，P=0.004）,which had statistical significance. Multivariate Logistic regression analysisshowed that acute hyperglycemia on admission is an independent risk factor for CINafter primary PCI（OR=3.369，95％CI:1.094-10.372；P=0.034）.Conclusions:1. The incidence of CIN of the acute hyperglycemia group is higher that the nonacute hyperglycemia group.2. Acute hyperglycemia on admission is an independent risk factor for CIN afterprimary percutaneous coronary intervention.