Mendi Mehmet Ali, Afsar Baris, Oksuz Fatih, Turak Osman, Yayla Cagri, Ozcan Firat, Johnson Richard J, Kanbay Mehmet
1 Department of Cardiology, Türkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
2 Department of Nephrology, Konya Numune Hospital, Konya, Turkey.
Angiology. 2017 Aug;68(7):627-632. doi: 10.1177/0003319716639187. Epub 2016 Mar 22.
Developing contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (pPCI) has a negative impact on survival and morbidity. We assessed the predictive value of serum uric acid (SUA) for the development of CIN in patients with ST-segment elevation myocardial infarction (STEMI) who underwent pPCI. Contrast-induced nephropathy was defined an increase of ≥25% or ≥0.5 mg/dL in creatinine concentrations within 72 hours after pPCI. Patients were divided into 2 groups according to admission median SUA level. Serum uric acid level was <5.4 mg/dL (group 1; n = 222) and ≥5.4 mg/dL (group 2; n = 228). Compared to group 1, development of CIN (12% vs 20%, P < .001) was significantly greater in group 2. Using a cut point of >5.45 mg/dL, the SUA level predicted development of CIN with a sensitivity of 70% and specificity of 67%. In multiple logistic regression analysis, SUA level, diabetes mellitus, left ventricular ejection fraction <50%, contrast volume, estimated glomerular filtration rate, and C-reactive protein level emerged as independent predictors of CIN. In conclusion, elevated SUA is an independent risk factor for the development of CIN after pPCI in patients with STEMI.
在直接经皮冠状动脉介入治疗（pPCI）后发生对比剂肾病（CIN）对生存率和发病率有负面影响。我们评估了血清尿酸（SUA）对接受pPCI的ST段抬高型心肌梗死（STEMI）患者发生CIN的预测价值。对比剂肾病定义为pPCI后72小时内肌酐浓度升高≥25%或≥0.5mg/dL。根据入院时SUA中位数水平将患者分为两组。血清尿酸水平<5.4mg/dL（第1组；n = 222）和≥5.4mg/dL（第2组；n = 228）。与第1组相比，第2组CIN的发生率（12%对20%，P <.001）显著更高。使用>5.45mg/dL的切点，SUA水平预测CIN发生的敏感性为70%，特异性为67%。在多因素逻辑回归分析中，SUA水平、糖尿病、左心室射血分数<50%、对比剂用量、估计肾小球滤过率和C反应蛋白水平是CIN的独立预测因素。总之，SUA升高是STEMI患者pPCI后发生CIN的独立危险因素。
