急性冠状动脉综合征患者接受旋转冠状动脉造影与传统冠状动脉造影时对比剂肾病发生情况的前瞻性评估：CINERAMA研究

Prospective evaluation of the development of contrast-induced nephropathy in patients with acute coronary syndrome undergoing rotational coronary angiography vs. conventional coronary angiography: CINERAMA study.

作者信息

Fernández-Rodríguez Diego, Grillo-Pérez José J, Pérez-Hernández Horacio, Rodríguez-Esteban Marcos, Pimienta Raquel, Acosta-Materán Carlos, Rodríguez Sara, Yanes-Bowden Geoffrey, Vargas-Torres Manuel J, Sánchez-Grande Flecha Alejandro, Hernández-Afonso Julio, Bosa-Ojeda Francisco

机构信息

Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Tenerife, España; Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, Lérida, España.

Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Tenerife, España.

出版信息

Nefrologia (Engl Ed). 2018 Mar-Apr;38(2):169-178. doi: 10.1016/j.nefro.2017.05.011. Epub 2017 Jul 19.

DOI:10.1016/j.nefro.2017.05.011

PMID:28734584

Abstract

INTRODUCTION AND OBJECTIVES

Rotational coronary angiography (RCA) requires less contrast to be administered and can prevent the onset of contrast-induced nephropathy (CIN) during invasive coronary procedures. The aim of the study is to evaluate the impact of RCA on CIN (increase in serum creatinine ≥0.5mg/dl or ≥25%) after an acute coronary syndrome.

METHODS

From April to September 2016, patients suffering acute coronary syndromes who underwent diagnostic coronary angiography, with the possibility of ad hoc coronary angioplasty, were prospectively enrolled. At the operator's discretion, patients underwent RCA or conventional coronary angiography (CCA). CIN (primary endpoint), as well as analytical, angiographic and clinical endpoints, were compared between groups.

RESULTS

Of the 235 patients enrolled, 116 patients received RCA and 119 patients received CCA. The RCA group was composed of older patients (64.0±11.8 years vs. 59.7±12.1 years; p=0.006), a higher proportion of women (44.8 vs. 17.6%; p<0.001), patients with a lower estimated glomerular filtration rate (76±25 vs. 86±27ml/min/1.73 m; p=0.001), and patients who underwent fewer coronary angioplasties (p<0.001) compared with the CCA group. Furthermore, the RCA group, received less contrast (113±92 vs. 169±103ml; p<0.001), including in diagnostic procedures (54±24 vs. 85±56ml; p<0.001) and diagnostic-therapeutic procedures (174±64 vs. 205±98ml; p=0.049) compared with the CCA group. The RCA group presented less CIN (4.3 vs. 22.7%; p<0.001) compared to the CCA group, and this finding was maintained in the regression analysis (Adjusted relative risk: 0.868; 95% CI: 0.794-0.949; p=0.002). There were no differences in clinical endpoints between the groups.

CONCLUSIONS

RCA was associated with lower administration of contrast during invasive coronary procedures in acute coronary syndrome patients, resulting in lower incidence of CIN, in comparison with CCA.

摘要

引言与目的

旋转冠状动脉造影（RCA）所需注射的造影剂较少，并且能够在侵入性冠状动脉手术过程中预防造影剂诱发的肾病（CIN）的发生。本研究的目的是评估RCA对急性冠状动脉综合征后CIN（血清肌酐升高≥0.5mg/dl或≥25%）的影响。

方法

2016年4月至9月，前瞻性纳入了因急性冠状动脉综合征而接受诊断性冠状动脉造影且有可能进行急诊冠状动脉血管成形术的患者。根据操作者的判断，患者接受RCA或传统冠状动脉造影（CCA）。对两组之间的CIN（主要终点）以及分析、血管造影和临床终点进行比较。

结果

在纳入的235例患者中，116例患者接受了RCA，119例患者接受了CCA。与CCA组相比，RCA组患者年龄更大（64.0±11.8岁对59.7±12.1岁；p = 0.006），女性比例更高（44.8%对17.6%；p<0.001），估计肾小球滤过率更低（76±25对86±27ml/min/1.73m²；p = 0.001），并且接受冠状动脉血管成形术的次数更少（p<0.001）。此外，与CCA组相比，RCA组接受的造影剂更少（113±92对169±103ml；p<0.001），包括在诊断性操作中（54±24对85±56ml；p<0.001）以及诊断-治疗性操作中（174±64对205±98ml；p = 0.049）。与CCA组相比，RCA组的CIN发生率更低（4.3%对22.7%；p<0.001），并且这一发现在回归分析中得到维持（调整后的相对风险：0.868；95%置信区间：0.794 - 0.949；p = 0.002）。两组之间的临床终点没有差异。