Du Mengyang, Jiang Lin, Tang Xiaofang, Gao Zhan, Xu Bo, Yuan Jinqing
Department of Cardiology, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Korean Circ J. 2021 Feb;51(2):174-181. doi: 10.4070/kcj.2020.0307.
This study investigated the relative incidence of contrast induced nephropathy (CIN) and long-term outcomes between iso-osmolar contrast media (IOCM) and low-osmolar contrast media (LOCM) undergoing elective percutaneous coronary intervention (PCI).
A total of 9,431 patients receiving elective PCI were enrolled in the cohort. The patients were divided into IOCM group and LOCM group. Propensity score matching (PSM) was applied to minimize the selection bias between groups.
The multivariate analysis showed that the use of IOCM compared with LOCM did not affect the CIN incidence (odds ratio [OR], 0.912; 95% confidence interval [CI], 0.576-1.446; p=0.696). After PSM, the incidence of CIN was 1.5% and 4.0% in IOCM group (n=979) and LOCM group (n=979), respectively, p=0.001. IOCM significantly reduced the incidence of CIN compared with LOCM (OR, 0.393; 95% CI, 0.214-0.722; p=0.003). After 2 years of follow-up, the all-cause mortality was higher in IOCM group than LOCM group (2.1% vs. 0.9%, p<0.001). Cox regression analysis showed IOCM was not independent risk factor of 2-years all-cause mortality (OR, 0.849; 95% CI, 0.510-1.412; p=0.528). After PSM, the difference of all-cause death between groups disappeared (1.7% vs. 1.9%, p=0.739). Cox regression analysis showed that the use of IOCM compared with LOCM did not affect the incidence of 2-year all-cause mortality (OR, 1.037; 95% CI, 0.534-2.014; p=0.915).
Compared with LOCM, IOCM significantly reduced the incidence of CIN after elective PCI, but had no significant effect on 2-year all-cause mortality.
本研究调查了等渗造影剂（IOCM）和低渗造影剂（LOCM）在接受择期经皮冠状动脉介入治疗（PCI）时对比剂肾病（CIN）的相对发生率及长期预后。
共有9431例接受择期PCI的患者纳入该队列。患者被分为IOCM组和LOCM组。应用倾向评分匹配（PSM）以最小化组间选择偏倚。
多因素分析显示，与LOCM相比，使用IOCM并不影响CIN发生率（比值比[OR]，0.912；95%置信区间[CI]，0.576 - 1.446；p = 0.696）。PSM后，IOCM组（n = 979）和LOCM组（n = 979）的CIN发生率分别为1.5%和4.0%，p = 0.001。与LOCM相比，IOCM显著降低了CIN发生率（OR，0.393；95% CI，0.214 - 0.722；p = 0.003）。随访2年后，IOCM组的全因死亡率高于LOCM组（2.1%对0.9%，p < 0.001）。Cox回归分析显示IOCM不是2年全因死亡率的独立危险因素（OR，0.849；95% CI，0.510 - 1.412；p = 0.528）。PSM后，组间全因死亡差异消失（1.7%对1.9%，p = 0.739）。Cox回归分析显示，与LOCM相比，使用IOCM并不影响2年全因死亡率的发生率（OR，1.037；95% CI，0.534 - 2.014；p = 0.915）。
与LOCM相比，IOCM在择期PCI后显著降低了CIN发生率，但对2年全因死亡率无显著影响。
