Department of Cardiology, Kyorin University School of Medicine, Mitaka, Japan.
Department of Emergency and General Medicine, Kyorin University School of Medicine, Mitaka, Japan.
Catheter Cardiovasc Interv. 2020 Dec;96(7):E666-E673. doi: 10.1002/ccd.28958. Epub 2020 May 8.
This study aimed to examine the feasibility and safety of noncontrast percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS).
Contrast-induced acute kidney injury (CI-AKI) occurs in 10-20% of ACS patients undergoing PCI, resulting in poor short- and long-term prognoses. Reducing the amount of contrast medium can prevent CI-AKI.
This was a prospective single-center study. In successful noncontrast PCI, contrast medium was not injected from guiding catheter engagement to wire removal in ad-hoc PCI. Coronary angiography after PCI was permitted once. CI-AKI was defined as an increase in the serum creatinine level of ≥0.5 mg/dl or ≥1.25 times the baseline within 72 hr post PCI. Worsening renal function (WRF) was defined as an increase in the serum creatinine level of ≥0.3 mg/dl from baseline after PCI.
This study included 106 lesions from 81 patients. Forty-eight (45%) lesions were Type C lesions. Successful noncontrast PCI was performed in 95 (90%) lesions. CI-AKI, coronary perforation, no/slow flow, and periprocedural death were observed in 4 (5%), 0, 9 (11%), and 0 patients, respectively. The follow-up period was 348 (190-492) days. Six-month WRF was observed in 18 individuals (22%). While successful noncontrast PCI was not associated with the incidence of CI-AKI, successful noncontrast PCI was inversely associated with WRF (hazard ratio, 0.28; 95% confidence interval, 0.09-0.90) after adjustment for renal function.
The present study suggests that noncontrast PCI is feasible and can be safely performed in ACS patients with complex lesions.
本研究旨在探讨急性冠脉综合征（ACS）患者行非对比经皮冠状动脉介入治疗（PCI）的可行性和安全性。
ACS 患者行 PCI 后约 10-20%会发生对比剂诱导的急性肾损伤（CI-AKI），导致短期和长期预后不良。减少对比剂用量可以预防 CI-AKI。
这是一项前瞻性单中心研究。在成功的非对比 PCI 中，在临时 PCI 中，从导引导管接合到导丝取出，不注射对比剂。允许在 PCI 后进行一次冠状动脉造影。PCI 后 72 小时内血清肌酐水平升高≥0.5mg/dl 或较基线升高≥1.25 倍定义为 CI-AKI。PCI 后肾功能恶化（WRF）定义为 PCI 后血清肌酐水平较基线升高≥0.3mg/dl。
本研究纳入了 81 例患者的 106 处病变。48 处（45%）病变为 C 型病变。95 处（90%）病变成功进行了非对比 PCI。4 例（5%）患者出现 CI-AKI、冠状动脉穿孔、无/慢血流和围手术期死亡，0 例患者出现，9 例（11%）患者出现，0 例患者出现。随访时间为 348（190-492）天。18 例（22%）患者出现 6 个月 WRF。在调整肾功能后，成功的非对比 PCI 与 CI-AKI 的发生率无关，但与 WRF 呈负相关（风险比，0.28；95%置信区间，0.09-0.90）。
本研究表明，非对比 PCI 对于复杂病变的 ACS 患者是可行的，并且可以安全进行。
