Sacha Jerzy, Gierlotka Marek, Lipski Przemysław, Feusette Piotr, Dudek Dariusz
Department of Cardiology, University Hospital, Faculty of Natural Sciences and Technology, University of Opole, Opole, Poland.
Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland.
Postepy Kardiol Interwencyjnej. 2019;15(2):137-142. doi: 10.5114/aic.2019.86008. Epub 2019 Jun 26.
Zero-contrast percutaneous coronary intervention (zero-PCI) is a new method for prevention of contrast-induced acute kidney injury (AKI) in patients with chronic kidney disease (CKD). However, evidence for its feasibility, safety and clinical utility is limited to reports of single cases or series of patients.
To present outcomes of zero-PCI in patients with severe CKD, including hemodialysis subjects, who were treated with this procedure in order to preserve their renal function.
Twenty-nine zero-PCIs were performed, mostly as a staged procedure, in 20 patients with advanced CKD. In this group, 4 patients were treated with hemodialysis but presented preserved residual renal function. The estimated median risk for contrast-induced AKI in non-dialysis patients was 26% (26-57%).
Zero-PCI was feasible in each intended patient, including those with complex left main stenosis or lesion within a saphenous vein graft, and there was no specific complication associated with this technique. After the procedure, the factual AKI prevalence was 10% and no patient required renal replacement therapy. Three of 4 hemodialysis patients preserved their residual renal function. During the median follow-up of 3.2 (1.2-5.3) months no patient experienced an acute coronary event or required revascularization.
Zero-PCI is a safe and promising method to preserve renal function in patients with CKD and hemodialysis patients. Such an approach is feasible even in complex coronary lesions and yields good clinical outcomes in mid-term observation.
零造影剂经皮冠状动脉介入治疗（零造影剂PCI）是预防慢性肾脏病（CKD）患者造影剂诱导的急性肾损伤（AKI）的一种新方法。然而，其可行性、安全性及临床实用性的证据仅限于单例报道或系列病例报告。
介绍重度CKD患者（包括接受血液透析的患者）接受零造影剂PCI以保护其肾功能的治疗结果。
对20例晚期CKD患者进行了29例零造影剂PCI，大多作为分期手术。该组中，4例接受血液透析但仍保留残余肾功能。非透析患者造影剂诱导的AKI估计中位风险为26%（26 - 57%）。
零造影剂PCI在每例预期患者中均可行，包括那些有复杂左主干狭窄或大隐静脉桥血管内病变的患者，且该技术无特定并发症。术后，实际AKI发生率为10%，无患者需要肾脏替代治疗。4例血液透析患者中有3例保留了残余肾功能。在中位随访3.2（1.2 - 5.3）个月期间，无患者发生急性冠状动脉事件或需要血运重建。
零造影剂PCI是保护CKD患者及血液透析患者肾功能的一种安全且有前景的方法。即使在复杂冠状动脉病变中，这种方法也是可行的，并且在中期观察中能产生良好的临床结果。
