Cardiac Catheterization Laboratories, Department of Cardiology, Rabin Medical Center, Petach Tikva and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Catheter Cardiovasc Interv. 2011 Aug 1;78(2):198-201. doi: 10.1002/ccd.22828. Epub 2010 Oct 14.
To assess the value of the ratio between contrast medium volume and glomerular filtration rate (CMGFRr) for prediction of development of contrast-induced nephropathy (CIN) and mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
Renal function is a strong predictor of outcome in patients with STEMI. CIN may complicate the course of primary PCI in these patients.
The study population included all 871 consecutive patients with STEMI without cardiogenic shock who underwent primary PCI at our center from January 1, 2001, to October 30, 2006. CIN was defined as an absolute increase in serum creatinine > 0.5 mg/dL or a relative increase >25% within 48 hr after PCI.
In-hospital CIN developed in 72 (8.3%) patients. On linear regression analysis, the following variables were independently associated with CIN: male sex (odds ratio [OR] = 0.42, 95% confidence interval [CI], 0.18-0.97, P = 0.04), GFR < 60 (OR = 3.6, 95% CI, 2.79-4.78, P < 0.0001), multivessel coronary artery disease (OR = 1.67, 95% CI, 1.08-2.58, P = 0.02), CMGFRr (OR = 1.53, 95% CI, 1.01-2.31, P = 0.04, for upper tertile vs. lower two tertiles), and Killip class > 1 (OR = 1.35, 95% CI, 1.03-1.76, P = 0.03). CMGFRr > 3.7 was a strong independent predictor of CIN (OR = 3.87, 95% CI, 1.72-8.68, P = 0.001). Twenty-six (2.9%) patients died at 1 month after PCI. The following variables were independently predictive of 1-month mortality: CMGFRr > 3.7 (OR = 3.3, 95% CI, 1.22-9.04, P = 0.018) and multivessel coronary artery disease (OR = 2.3, 95% CI, 1.28-4.07, P = 0.005).
The contrast medium-to-GFR ratio is a strong predictor of CIN and of 1-month mortality in patients undergoing primary PCI for STEMI.
评估对比剂体积与肾小球滤过率（CMGFRr）比值在预测 ST 段抬高型急性心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PCI）后发生对比剂肾病（CIN）和死亡率中的价值。
肾功能是 STEMI 患者预后的一个强有力的预测因素。CIN 可能使这些患者的直接 PCI 过程复杂化。
本研究纳入了 2001 年 1 月 1 日至 2006 年 10 月 30 日在我院行直接 PCI 的 871 例无心源性休克的连续 STEMI 患者。CIN 定义为 PCI 后 48 小时内血清肌酐绝对值增加>0.5mg/dL 或相对增加>25%。
72 例（8.3%）患者发生院内 CIN。线性回归分析显示，以下变量与 CIN 独立相关：男性（比值比[OR] = 0.42，95%置信区间[CI]，0.18-0.97，P = 0.04）、GFR < 60（OR = 3.6，95%CI，2.79-4.78，P < 0.0001）、多支冠状动脉疾病（OR = 1.67，95%CI，1.08-2.58，P = 0.02）、CMGFRr（OR = 1.53，95%CI，1.01-2.31，P = 0.04，上三分位数与下两个三分位数相比）和 Killip 分级>1（OR = 1.35，95%CI，1.03-1.76，P = 0.03）。CMGFRr > 3.7 是 CIN 的一个独立强预测因子（OR = 3.87，95%CI，1.72-8.68，P = 0.001）。26 例（2.9%）患者在 PCI 后 1 个月死亡。以下变量是 1 个月死亡率的独立预测因素：CMGFRr > 3.7（OR = 3.3，95%CI，1.22-9.04，P = 0.018）和多支冠状动脉疾病（OR = 2.3，95%CI，1.28-4.07，P = 0.005）。
CMGFRr 是直接 PCI 治疗 STEMI 患者发生 CIN 和 1 个月死亡率的一个强有力的预测因子。
