Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
Beaumont Hospital Royal Oak, Royal Oak, Michigan.
Catheter Cardiovasc Interv. 2019 Feb 1;93(2):222-230. doi: 10.1002/ccd.27819. Epub 2018 Aug 25.
The risk of contrast-induced acute kidney injury (CI-AKI) increases in a nonlinear fashion with increasing volume of contrast media. Prior studies recommend limiting contrast volume to less than three times the estimated creatinine clearance (CC). Recently, a number of operators have reported successful percutaneous coronary intervention (PCI) using even lower volumes of contrast.
To evaluate the prevalence and outcomes associated with ultra-low contrast volume among patients undergoing PCI.
We assessed the prevalence and outcomes associated with use of ultra-low contrast volume among 75 393 patients undergoing PCI in Michigan between July 2014 and June 2017 in the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry. Ultra-low contrast volume was defined as contrast volume less than or equal to the patient's estimated CC. Patients receiving dialysis at the time of the procedure were excluded.
Ultra-low contrast volume was used in 13% of procedures with the majority of these patients being at low risk of renal complications. Compared with patients who received a contrast volume between one and three times the CC, use of ultra-low volume of contrast was associated with a significantly lower incidence of AKI (aOR 0.682, 95% CI 0.566-0.821, P < 0.001) and a lower incidence of need for dialysis (aOR = 0.341, 95% CI 0.165-0.704, P = 0.003). These benefits were most evident in the patients with a high baseline predicted risk of AKI.
A small but clinically significant number of patients are treated with ultra-low contrast volume. Ultra-low contrast volume use is associated with a significant reduction in the incidence of AKI or need for dialysis. It may be prudent to consider this new threshold when performing PCI on patients who are at an increased risk of AKI.
随着造影剂用量的增加，对比剂诱导的急性肾损伤（CI-AKI）的风险呈非线性增加。先前的研究建议将造影剂用量限制在估计肌酐清除率（CC）的三倍以下。最近，许多术者报告了使用甚至更低造影剂用量的成功经皮冠状动脉介入治疗（PCI）。
评估 PCI 患者中使用超低造影剂体积的患病率和相关结局。
我们评估了 2014 年 7 月至 2017 年 6 月期间密歇根州 BMC2（蓝十字蓝盾密歇根州心血管联合会）注册中心 75393 例行 PCI 的患者中超低造影剂体积的使用情况及其相关结局。超低造影剂体积定义为造影剂体积小于或等于患者的估计 CC。在手术时接受透析的患者被排除在外。
13%的手术中使用了超低造影剂体积，其中大多数患者的肾脏并发症风险较低。与接受 CC 一至三倍造影剂体积的患者相比，使用超低造影剂体积与 AKI 的发生率显著降低相关（比值比 0.682，95%置信区间 0.566-0.821，P<0.001），需要透析的发生率也显著降低（比值比 0.341，95%置信区间 0.165-0.704，P=0.003）。这些益处在基线预测 AKI 风险较高的患者中最为明显。
尽管数量较少，但有相当一部分患者接受了超低造影剂体积治疗。使用超低造影剂体积与 AKI 或需要透析的发生率显著降低相关。对于 AKI 风险增加的患者行 PCI 时，考虑这一新阈值可能是谨慎的。
