Kanei Yumiko, Ayabe Kengo, Ratcliffe Justin, Vales Lori, Nakra Navin, Friedman Patricia, Fox John
Beth Israel Medical Center, Cardiology, 1st Avenue at 16th Street, New York, NY 10003, USA.
J Invasive Cardiol. 2011 Nov;23(11):448-50.
The incidence of contrast-induced nephropathy (CIN) in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) was previously reported to be as high as 19%. Iso-osmolar contrast has frequently been used for populations at high risk for CIN, but a recent meta-analysis did not show a significant benefit of using iso-osmolar contrast in preventing CIN. The aim of our study is to evaluate the impact of iso-osmolar contrast use in patients undergoing emergent PCI. We performed a retrospective analysis of patients who underwent primary and rescue PCI for STEMI. The PCI strategy, including the contrast choice, was left at the discretion of the operator. CIN was defined as an increase in creatinine of more than 0.5 mg or 25% from the baseline within 72 hours. Among 212 patients, CIN was seen in 33 patients (16%). Patients who received iso-osmolar contrast were older, and included more patients at risk for CIN. The incidence of CIN was 14% in the low-osmolar contrast group and 17% in the iso-osmolar contrast group (P=.799). After logistic regression analysis, CIN was seen more frequently in patients who had lower ejection fraction, post-PCI TIMI flow <3, and lower hemoglobin. The use of iso-osmolar contrast was not associated with a lower incidence of CIN in patients undergoing emergent PCI for STEMI.
先前报道，在接受经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者中，造影剂肾病（CIN）的发生率高达19%。等渗造影剂常用于发生CIN风险较高的人群，但最近的一项荟萃分析并未显示使用等渗造影剂在预防CIN方面有显著益处。我们研究的目的是评估在接受急诊PCI的患者中使用等渗造影剂的影响。我们对接受STEMI初次和补救PCI的患者进行了回顾性分析。PCI策略，包括造影剂的选择，由操作者自行决定。CIN定义为肌酐在72小时内较基线水平升高超过0.5 mg或升高25%。在212例患者中，33例（16%）出现CIN。接受等渗造影剂的患者年龄较大，且CIN风险较高的患者更多。低渗造影剂组CIN的发生率为14%，等渗造影剂组为17%（P = 0.799）。经逻辑回归分析后，射血分数较低、PCI术后心肌梗死溶栓试验（TIMI）血流<3以及血红蛋白较低的患者中CIN更为常见。在接受STEMI急诊PCI的患者中，使用等渗造影剂与CIN发生率较低无关。
