Mankerious Nader, Hemetsberger Rayyan, Samy Mohamed, Elbasha Karim, Kandil Nader, Elawady Mohamed, Toelg Ralph, Abdel-Wahab Mohamed, Richardt Gert, Allali Abdelhakim
Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany; Cardiology Department, Zagazig University, Sharkia, Egypt.
Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany.
Cardiovasc Revasc Med. 2023 Feb;47:18-24. doi: 10.1016/j.carrev.2022.08.035. Epub 2022 Aug 27.
Rotational atherectomy (RA) is a complex procedure often associated with high contrast load. Known risk scores do not predict contrast-induced acute kidney injury (CI-AKI) before RA. We aim to investigate pre-procedural predictors of CI-AKI after RA, and the role of the target vessel SYNTAX score (tvSS).
Among 295 patients who underwent RA between 01.2010 and 02.2019 at a single center, 49 developed CI-AKI. Those who were on chronic hemodialysis or with no available 48-h' kidney function tests were excluded. Predictors of CI-AKI were assessed in the whole cohort and those with no basal renal impairment.
The rate of CI-AKI was 16.6 %. The tvSS was 18 [14-23] vs. 12 [9-18] in patients with vs. without CI-AKI (p < 0.001). The tvSS cut-off value of 15 provided 75 % sensitivity and 60 % specificity for predicting CI-AKI. Consequently, a tvSS ≥15 emerged as an independent pre-procedural predictor for CI-AKI (adjusted OR: 4.94, 95 % CI: 2.38-10.20, p < 0.001), along with left ventricular ejection fraction (LVEF) ≤35 % (p = 0.016) and glomerular filtration rate (GFR) <45 ml/min (p = 0.004). TvSS was the only independent pre-procedural predictor for CI-AKI in patients with GFR ≥60 ml/min (p < 0.001). The contrast volume/GFR ratio and peri-procedural myocardial infarction (MI) were independent procedural predictors for CI-AKI in the whole cohort and in patients with basal GFR ≥60 ml/min.
CI-AKI after RA is frequent. The tvSS is an efficient pre-procedural predictor for CI-AKI after RA, along with LVEF ≤35 % and GFR <45 ml/min. Contrast volume/GFR ratio and peri-procedural MI emerged as procedural predictors for CI-AKI.
旋磨术（RA）是一种复杂的手术，常伴随着高造影剂负荷。已知的风险评分无法在RA术前预测造影剂诱发的急性肾损伤（CI-AKI）。我们旨在研究RA术后CI-AKI的术前预测因素，以及靶血管SYNTAX评分（tvSS）的作用。
在2010年1月至2019年2月于单一中心接受RA手术的295例患者中，49例发生了CI-AKI。排除那些接受慢性血液透析或无法进行48小时肾功能检查的患者。在整个队列以及无基础肾功能损害的患者中评估CI-AKI的预测因素。
CI-AKI的发生率为16.6%。发生CI-AKI的患者与未发生CI-AKI的患者相比，tvSS分别为18[14-23]和12[9-18]（p<0.001）。tvSS临界值为15时，预测CI-AKI的敏感性为75%，特异性为60%。因此，tvSS≥15成为CI-AKI的独立术前预测因素（校正OR：4.94，95%CI：2.38-10.20，p<0.001），同时还有左心室射血分数（LVEF）≤35%（p=0.016）和肾小球滤过率（GFR）<45ml/min（p=0.004）。在GFR≥60ml/min的患者中，tvSS是CI-AKI唯一的独立术前预测因素（p<0.001）。在整个队列以及基础GFR≥60ml/min的患者中，造影剂用量/GFR比值和围手术期心肌梗死（MI）是CI-AKI的独立手术预测因素。
RA术后CI-AKI很常见。tvSS是RA术后CI-AKI的有效术前预测因素，同时还有LVEF≤35%和GFR<45ml/min。造影剂用量/GFR比值和围手术期MI成为CI-AKI的手术预测因素。
