Raposeiras-Roubín Sergio, Abu-Assi Emad, Ocaranza-Sánchez Raymundo, Alvarez-Álvarez Belén, Cambeiro-González Cristina, Fandiño-Vaquero Rubén, García-Castelo Alberto, García-Acuña José María, González-Juanatey José Ramón
Cardiology Department, University Hospital of Santiago de Compostela, Spain.
Catheter Cardiovasc Interv. 2013 Nov 15;82(6):888-97. doi: 10.1002/ccd.24847. Epub 2013 Jul 17.
Previous studies on contrast-induced nephropathy (CIN) have identified contrast volume (CV) as a risk factor. The aim of our research was to define the safe dose of contrast media based on absolute CV, maximum allowable contrast dose (MACD) and estimated glomerular filtrate rate (eGFR).
A total of 940 consecutive patients with acute coronary syndrome (ACS) were enrolled. Fifty-four patients developed CIN. MACD was defined as 5*body weight/serum creatinine. When using a CV higher than MACD, CIN-risk was increased 19-fold (OR 9.810-39.307, P < 0.001). For the CV/eGFR ratio, we found that for every increase of one-tenth, CIN-risk increased by 4.9% (OR 1.037-1.061, P < 0.001). The discriminative ability of CV (C statistic = 0.626 ± 0.038) was significantly lower than for the CV/MACD (C statistic = 0.782 ± 0.036, P = 0.003) and CV/eGFR (C statistics: 0.796 ± 0.033 for MDRD-4, 0.796 ± 0.034 for Cockcroft-Gault, and 0.803 ± 0.033 for CKD-EPI; P < 0.001). There were no differences in the discriminative ability to predict CIN between the three eGFR equations. The combination of CV/MACD and CV/eGFR in a single protocol increases the positive predictive value of the Mehran risk score (40.7% vs. 8.8%) with the same sensitivity (90.7% vs. 83.3%). High doses of relative CV (CV/MACD and CV/eGFR) were also significantly associated with higher in-hospital mortality, reinfarction, and heart failure.
A sequential protocol based on CV/MACD and CV/eGFR appropriately identified those ACS patients who developed CIN, with predictive values similar to a Mehran score, reducing the false positive rate. It is also useful to predict risk of in-hospital cardiac events regardless of GRACE score.
既往关于对比剂肾病（CIN）的研究已将对比剂用量（CV）确定为一个危险因素。我们研究的目的是根据绝对CV、最大允许对比剂剂量（MACD）和估计肾小球滤过率（eGFR）来确定对比剂的安全剂量。
共纳入940例连续的急性冠脉综合征（ACS）患者。54例患者发生了CIN。MACD定义为5×体重/血清肌酐。当使用高于MACD的CV时，CIN风险增加19倍（比值比9.810 - 39.307，P < 0.001）。对于CV/eGFR比值，我们发现每增加十分之一，CIN风险增加4.9%（比值比1.037 - 1.061，P < 0.001）。CV的判别能力（C统计量 = 0.626 ± 0.038）显著低于CV/MACD（C统计量 = 0.782 ± 0.036，P = 0.003）和CV/eGFR（MDRD - 4的C统计量：0.796 ± 0.033，Cockcroft - Gault的C统计量：0.796 ± 0.034，CKD - EPI的C统计量：0.803 ± 0.033；P < 0.001）。三种eGFR方程在预测CIN的判别能力上没有差异。在单一方案中结合CV/MACD和CV/eGFR可提高梅兰风险评分的阳性预测值（40.7%对8.8%），同时敏感性相同（90.7%对83.3%）。高剂量的相对CV（CV/MACD和CV/eGFR）也与较高的住院死亡率、再梗死和心力衰竭显著相关。
基于CV/MACD和CV/eGFR的序贯方案能恰当识别那些发生CIN的ACS患者，其预测值与梅兰评分相似，降低了假阳性率。无论GRACE评分如何，它对于预测住院心脏事件风险也很有用。
