Cardiovascular Division, Department of Medicine II, Kansai Medical University, Hirakata, Osaka, Japan.
Am J Cardiol. 2010 Mar 1;105(5):624-8. doi: 10.1016/j.amjcard.2009.10.044.
Contrast-induced nephropathy (CIN) is associated with significantly increased morbidity and mortality after coronary angiography and percutaneous coronary intervention (PCI). The aim of the present study was to assess the clinical features and in-hospital outcomes of CIN after emergency PCI. The serum creatinine (SCr) concentration was measured from days 0 to 30 in 338 consecutive patients with acute coronary syndrome undergoing emergency PCI. CIN was defined as an increase in SCr of >25% or >0.5 mg/dl within 2 days after PCI. Overall, 94 patients (28%) developed CIN. The mean SCr on admission was not significantly different between patients with CIN and those without CIN. The CIN group had significantly greater SCr at days 1, 2, and 30 than did the no CIN group. Multivariate analysis showed female gender (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.12 to 5.07, p = 0.025), a culprit lesion in the left anterior descending artery (OR 2.37, 95% CI 1.31 to 4.27, p = 0.0042), contrast agent volume >200 ml (OR 3.60, 95% CI 1.96 to 6.62, p <0.001) and end-diastolic pulmonary arterial pressure >15 mm Hg (OR 2.03, 95% CI 1.02 to 4.04, p <0.01) to all correlate independently with CIN. The in-hospital mortality rate was greater in the CIN group than in the no CIN group (9.6% vs 3.3%, respectively; p = 0.025). In conclusion, CIN is a frequent complication of emergency PCI for acute coronary syndrome and is associated with a greater mortality rate and persistent renal dysfunction.
对比剂肾病（CIN）与冠状动脉造影和经皮冠状动脉介入治疗（PCI）后的发病率和死亡率显著增加相关。本研究旨在评估急性冠状动脉综合征患者行急诊 PCI 后 CIN 的临床特征和住院结局。连续 338 例接受急诊 PCI 的急性冠状动脉综合征患者在 0 至 30 天内检测血清肌酐（SCr）浓度。CIN 定义为 PCI 后 2 天内 SCr 增加>25%或>0.5mg/dl。总体而言，94 例患者（28%）发生 CIN。CIN 组和无 CIN 组入院时的 SCr 均值无显著差异。CIN 组在第 1、2 和 30 天的 SCr 显著高于无 CIN 组。多变量分析显示，女性（比值比 [OR] 2.38，95%置信区间 [CI] 1.12 至 5.07，p = 0.025）、左前降支罪犯病变（OR 2.37，95% CI 1.31 至 4.27，p = 0.0042）、造影剂用量>200ml（OR 3.60，95% CI 1.96 至 6.62，p <0.001）和舒张末期肺动脉压>15mmHg（OR 2.03，95% CI 1.02 至 4.04，p <0.01）均与 CIN 独立相关。CIN 组的住院死亡率高于无 CIN 组（分别为 9.6%和 3.3%；p = 0.025）。总之，CIN 是急性冠状动脉综合征患者急诊 PCI 的常见并发症，与更高的死亡率和持续肾功能障碍相关。
