Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
J Zhejiang Univ Sci B. 2013 Aug;14(8):713-20. doi: 10.1631/jzus.BQICC706.
Slight elevations in cardiac troponin I and T are frequently observed after percutaneous coronary intervention (PCI). Contrast-induced acute kidney injury (CI-AKI) is a complex syndrome induced by exposure to intravascular contrast media (CM). Currently, the relationships between the CM, pre-existing kidney insufficiency, CI-AKI, and myonecrosis after elective PCI are unclear. To investigate the relationship between CI-AKI and post-procedural myonecrosis (PMN) after PCI, we analyzed 327 non-ST-segment elevation acute coronary syndrome subjects undertaking elective PCI. The levels of cardiac troponins (cTns), cTnI and cTnT, at baseline and on at least one occasion 18-24 h after PCI were measured. We also recorded serum levels of creatinine (SCr) and the urine albumin:creatinine ratio (ACR) before coronary angiography, and 24-48 h and 48-72 h after contrast administration. A post-procedure increase in cTns was detected in 16.21% (53/327) of subjects with cTns levels >99th to 5×99th percentile upper reference limit (URL). Twenty-seven patients (8.26%) developed CI-AKI. CI-AKI occurred more often in subjects with PMN than in those without PMN (20.8% versus 5.8%, respectively, P=0.001). Multiple logistic regression analysis revealed that pre-existing microalbuminuria (MA) was an important independent predictor of PMN (OR: 3.31; 95% CI: 1.26-8.65, P=0.01). However, there was no correlation between the incidence of CI-AKI and PMN (OR: 2.38; 95% CI: 0.88-6.46, P=0.09). We conclude that pre-existing MA was not only an important independent predictor of CI-AKI but also of PMN.
经皮冠状动脉介入治疗（PCI）后常观察到心肌肌钙蛋白 I 和 T 轻度升高。对比剂诱导的急性肾损伤（CI-AKI）是一种由血管内对比剂（CM）暴露引起的复杂综合征。目前，CM、预先存在的肾功能不全、CI-AKI 和择期 PCI 后肌坏死之间的关系尚不清楚。为了研究 CI-AKI 与 PCI 后即刻肌坏死（PMN）之间的关系，我们分析了 327 例非 ST 段抬高型急性冠状动脉综合征患者行择期 PCI。在基线和 PCI 后至少 18-24 小时测量心肌肌钙蛋白（cTns）、cTnI 和 cTnT 的水平。我们还记录了冠状动脉造影前、造影后 24-48 小时和 48-72 小时血清肌酐（SCr）和尿白蛋白：肌酐比值（ACR）。在 16.21%（53/327）的患者中检测到 cTns 术后升高，cTns 水平>99%至 5×99%上限参考范围（URL）。27 例患者（8.26%）发生 CI-AKI。PMN 患者比无 PMN 患者更易发生 CI-AKI（分别为 20.8%和 5.8%，P=0.001）。多因素逻辑回归分析显示，预先存在的微量白蛋白尿（MA）是 PMN 的重要独立预测因子（OR：3.31；95%CI：1.26-8.65，P=0.01）。然而，CI-AKI 的发生率与 PMN 之间无相关性（OR：2.38；95%CI：0.88-6.46，P=0.09）。我们的结论是，预先存在的 MA 不仅是 CI-AKI 的重要独立预测因子，也是 PMN 的重要独立预测因子。
