Contrast-induced Acute Kidney Injury After Coronary Angiography Compare With Coronary CTA In Elderly Patients

Objectives:The aim of this study is to assess the risk of Contrast-induced acute kidney injury(CIAKI)in patients who undergoing coronary angiography or coronary Computed Tomography Angiography(CTA)examination.We evaluated the effect of hydration on prevent CIAKI and compared different types of contrast agents on the incidence of CIAKI.Methods:Patients who were 65 years old or older and under through coronary angiography or coronary CTA examination at the Guangdong general hospital from September 2015 to December 2017 were enrolled in this study.We analyzed and compared clinical markers such as serum creatinine before and 3 days after coronary angiography or coronary CTA examination,and collected the dose and type of hydration and contrast media,compared the incidence of CIAKI of this two groups.Results:A total of 462 patients were enrolled in this study.According to the different examinations,the patients were divided into two groups:the coronary CTA examination group(n=232)and the coronary angiography group(n=230).The average age of the two groups were 73.03±6.01 and 73.73±6.35 years old,respectively.The difference was not statistically significant.Also,There was no significant difference in gender,height,weight,previous history of hypertension,diabetes,anemia or hyperuricacidemia.A total of 97 patients in the coronary angiography group received hydration prophylaxis,accounting for 41.81%of the total number of patients in this group.A total of 131 patients were treated with hydration during coronary CTA examinations,accounting for 56.96%of the total number of patients in the group.After hydration,CIAKI occurred in 4 patients(4.1%)in the coronary angiography group and 3 patients(2.3%)in coronary CTA group,respectively,which were lower than without hydration prevention group.In the cases of without hydration,the incidence of CIAKI in the coronary CTA group was higher than in the coronary angiography group(19(19.2%)vs 9(6.7%),P<0.05),and there was a statistical difference.The multiple logistic regression analysis showed that the risk ratio of CIAKI after coronary CTA examination compared with coronary angiography was 2.500,95%CI.1.033,6.047,P=0.042.In patients undergoing coronary CTA examination,a total of 131 patients received hydration therapy to prevent contrast nephropathy,of which 67 patients received oral hydration and 64 patients received intravenous hydration.The serum creatinine level decreased more in the intravenous hydration group within 3 days.There was one patients developed to CIAKI,accounting for 1.6%,while in the oral hydration group,2 patients developed contrast-induced nephropathy,accounting for 1.5%of the oral hydration group.There was no significant difference between the oral group and the hydration group,p=0.582.The hypotonic contrast agent was used in the coronary CTA group and the hypotonic contrast agent was used in 91.8%of the coronary angiography group.Only 19 patients were treated with isotonic contrast agents.Regardless of hydration,there was no significant difference in CIAKI incidence between the two groups.In the coronary CTA group,all patients used a hypotonic contrast agent.In the hydration group,patients with iopromide-370 as a contrast agent had a higher incidence of CIAKI,accounting for 5.9%,in the anhydrous The highest incidence of ibuprofen-370 was used in the chemotherapy group,accounting for 23.5%;however,there was no statistically significant difference between contrast agents with or without hydration.Conclusion:Compared with coronary angiography,coronary CTA is more likely to cause contrast induced acute kidney injury,which may be related to the use of more contrast agent dose.Hydration therapy can effectively reduce the incidence of CIAKI,and there is no significant difference between oral hydration and intravenous hydration.There was no significant difference in the incidence of CIAKI among different hypotonic contrast agents in coronary CTA examination.