Luo Yu, Wang Xiaodong, Ye Zi, Lai Yan, Yao Yian, Li Jimin, Liu Xuebo
Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, China.
Intern Med. 2014;53(20):2265-72. doi: 10.2169/internalmedicine.53.1853. Epub 2014 Oct 15.
The aim of this study was to investigate whether remedial hydration (RH) reduces the incidence of contrast-induced nephropathy (CIN) and short-term adverse events in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
A total of 216 consecutive STEMI patients were prospectively and randomly assigned into two groups: 108 patients in the RH group and 108 patients in the no RH (control) group. The serum creatinine (SCr) and creatinine clearance (CCr) levels were measured on admission and at 24, 48 and 72 hours after primary PCI. The rates of CIN and short-term adverse events were analyzed for each group. After surgery, the patients were categorized into four groups according to the Mehran risk score: low (≤5, n =98), moderate (6-10, n=56), high (11-15, n=40) or very high (≥16, n=22).
The incidence of CIN in the RH group was lower than that observed in the control group (22/108; 20.4% vs. 38/108; 35.2%, p<0.05). The subgroup analysis showed that the rate of CIN was lower in the moderate (6/29; 20.7% vs. 13/30; 43.3%, p<0.10) and significantly lower in both the high (5/21; 23.8% vs. 10/18; 55.6%, p<0.05) and very high score groups (3/12; 25.0% vs. 8/12; 66.7%, p<0.05) among the RH patients compared to the controls. At 24, 48 and 72 hours after PCI, the patients in the RH group exhibited lower SCr levels and higher CCr levels than the patients in the control group (both p<0.05). A lower incidence of in-hospital clinical events was also observed in the RH group.
Remedial hydration decreases the occurrence of CIN and improves the short-term prognosis of STEMI patients undergoing primary PCI.
本研究旨在探讨补救性水化（RH）是否能降低接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者对比剂肾病（CIN）的发生率及短期不良事件。
216例连续的STEMI患者被前瞻性随机分为两组：RH组108例，非RH（对照组）组108例。在入院时以及直接PCI术后24、48和72小时测量血清肌酐（SCr）和肌酐清除率（CCr）水平。分析每组CIN和短期不良事件的发生率。术后，根据梅兰风险评分将患者分为四组：低（≤5，n = 98）、中（6 - 10，n = 56）、高（11 - 15，n = 40）或极高（≥16，n = 22）。
RH组CIN的发生率低于对照组（22/108；20.4% 对比 38/108；35.2%，p < 0.05）。亚组分析显示，与对照组相比，RH组中中度风险组（6/29；20.7% 对比 13/30；43.3%，p < 0.10）CIN发生率较低，高风险组（5/21；23.8% 对比 10/18；55.6%，p < 0.05）和极高风险组（3/12；25.0% 对比 8/12；66.7%，p < 0.05）CIN发生率显著较低。在PCI术后24、48和72小时，RH组患者的SCr水平低于对照组，CCr水平高于对照组（均p < 0.05）。RH组住院临床事件的发生率也较低。
补救性水化可降低CIN的发生，并改善接受直接PCI的STEMI患者的短期预后。
