University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA.
Department of Internal Medicine, John A. Burns School of Medicine, Honolulu, HI, USA.
Cardiovasc Revasc Med. 2020 Nov;21(11):1377-1385. doi: 10.1016/j.carrev.2020.04.040. Epub 2020 May 4.
Contrast-induced nephropathy (CIN) frequently occurs following coronary angiography (CAG) and is associated with worse outcomes, including both short and long-term mortality. Previous studies reported an association between procedural hyperglycemia (PH) and CIN, with or without diabetes mellitus (DM). We performed a systematic review and meta-analysis to explore the association of PH and CIN in patients undergoing CAG.
We searched the databases of MEDLINE and EMBASE from inception to January 2020. Included studies investigated CIN incidence in patients undergoing CAG. Data from each study were combined using the random-effects model.
A total of eight studies were included in this meta-analysis. We found that PH was associated with an increased risk of CIN following CAG (pooled OR = 1.71, 95%CI:1.35-2.16, where PH was defined as ≥140 mg/dl; and pooled OR = 2.07, 95%CI:1.80-2.37, where PH was defined as ≥200 mg/dl). In subgroup analysis of non-diabetic patients and STEMI patients undergoing primary percutaneous coronary intervention, we found that PH was associated with an increased risk of CIN in both subgroups, where PH was defined as ≥140 mg/dl and ≥200mg/dl (p-value < 0.05).
Our meta-analysis demonstrated that PH significantly increases the risk of CIN following CAG, in both diabetic and non-diabetic populations. Further studies are needed to evaluate whether strict blood glucose control can reduce the incidence of CIN in this population.
冠状动脉造影（CAG）后常发生对比剂诱导的肾病（CIN），与更差的结局相关，包括短期和长期死亡率。先前的研究报告了术中性高血糖（PH）与 CIN 之间的关联，无论是否存在糖尿病（DM）。我们进行了一项系统评价和荟萃分析，以探讨 CAG 患者中 PH 与 CIN 的关系。
我们从 MEDLINE 和 EMBASE 数据库中搜索了从成立到 2020 年 1 月的文献。纳入的研究调查了 CAG 患者的 CIN 发生率。使用随机效应模型合并每个研究的数据。
共有 8 项研究纳入了这项荟萃分析。我们发现，CAG 后 PH 与 CIN 风险增加相关（合并 OR=1.71，95%CI：1.35-2.16，PH 定义为≥140mg/dl；合并 OR=2.07，95%CI：1.80-2.37，PH 定义为≥200mg/dl）。在非糖尿病患者和接受直接经皮冠状动脉介入治疗的 STEMI 患者的亚组分析中，我们发现 PH 与这两个亚组的 CIN 风险增加相关，PH 定义为≥140mg/dl 和≥200mg/dl（p 值均<0.05）。
我们的荟萃分析表明，PH 显著增加了 CAG 后 CIN 的风险，无论在糖尿病患者还是非糖尿病患者中。需要进一步的研究来评估严格的血糖控制是否可以降低该人群中 CIN 的发生率。
