Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction: Is it Affected by Treatment Strategy?

BACKGROUND

Contrast-induced nephropathy (CIN) is a frequent complication after percutaneous coronary intervention (PCI) and severely affects morbidity and mortality, especially in patients with ST-segment elevation myocardial infarction.

OBJECTIVE

This study sought to determine the incidence, risk factors, and in-hospital outcome of CIN in patients with ST-segment elevation myocardial infarction managed by pharmacoinvasive strategy (PIS) versus those managed by primary PCI (PPCI).

METHODS

The study was conducted on 670 patients with ST-segment elevation myocardial infarction divided into 2 groups: group I (PPCI group) and group II (PIS group), the 2 groups were compared with each other for the incidence of CIN, risk factors, and in-hospital major adverse cardiac events.

RESULTS

The incidence of CIN in the PIS group (30 patients, 8.8%) was lower than PPCI group (36 patients, 10.9%); however, there was no statistically significant difference between the 2 groups (p = 0.365). Multivariate regression analysis showed that advanced age >60 years (odds ratio [OR] = 4.453; 95% confidence interval [CI]: 2.489 to -7.967; p = 0.001), history of diabetes mellitus (OR = 2.366; 95% CI: 1.298 to -4.315; p = 0.005) and hypertension (OR = 1.930; 95% CI: 1.053 to -3.539; p = 0.034), volume of contrast agent >180 ml (OR = 2.276; 95% CI: 1.290 to -4.016; p = 0.005), and cardiogenic shock (OR = 4.098; 95% CI: 1.726 to -9.728; p = 0.001) were the independent predictors of CIN. Mortality and major adverse cardiac events were significantly higher in patients with CIN.

CONCLUSIONS

The incidence of CIN was slightly lower in PIS as compared to PPCI; however, this reduction was not statistically significant. The independent predictors of CIN were advanced age, history of diabetes mellitus and hypertension, high dose of contrast agent, and cardiogenic shock.