Department of Cardiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
Department of Cardiology, Lujiang People Hospital, Anhui, China.
Am J Cardiol. 2023 May 15;195:77-82. doi: 10.1016/j.amjcard.2023.03.001. Epub 2023 Apr 3.
Tailored hydration strategies appear to provide an effective solution for preventing contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). The Vigileo/FloTrac system could predict the patients' fluid responsiveness and tolerance to hydration. This prospective multicenter, randomized controlled, open-label study evaluated the efficacy of aggressive hydration guided by the Vigileo/FloTrac system for CIN prevention in patients with acute myocardial infarction (AMI). This trial enrolled patients with AMI undergoing urgent PCI, and these patients were randomized (1:1) to receive either aggressive hydration guided by Vigileo/FloTrac system (intervention group) or general hydration (control group). Patients with AMI in the intervention group received a loading dose of saline, and the hydration speed was adjusted according to the change of Vigileo/FloTrac index. The primary end point is CIN, which was defined as a >25% or >0.5 mg/100 ml increase in serum creatinine compared with baseline during the first 72 hours after urgent PCI. This trial was registered in ClinicalTrials.gov (NCT04382313). A total of 344 patients with AMI were enrolled and randomized in our trial, and the baseline characteristics, including risk factors of CIN, of the Vigileo/FloTrac-guided hydration group (n = 173) and control group (n = 171) were well balanced (all p >0.05). The total hydration volume in Vigileo/FloTrac-guided hydration group was significantly much more than control group (1,910 ± 600 vs 440 ± 90 ml, p <0.001). The incidence of CIN in the Vigileo/FloTrac-guided hydration group was significantly decreased than that in the control group (12.1% [21/173] vs 22.2% [38/171], p = 0.013). There was not significantly different in the incidence of acute heart failure after PCI (9.2% [16/173] vs 7.6% [13/171], p = 0.583). The incidence of main adverse cardiovascular events in the Vigileo/FloTrac-guided hydration group was lower than that in the control group but without statistically difference (30 events [17.3%] vs 38 events [22.2%], p = 0.256). In conclusion, Vigileo/FloTrac system-guided aggressive hydration could effectively decrease the risk of CIN for patients with AMI undergoing urgent PCI and avoid attack of acute heart failure at the same time.
个体化水化策略似乎是预防经皮冠状动脉介入治疗（PCI）后对比剂肾病（CIN）的有效方法。Vigileo/FloTrac 系统可预测患者对液体反应性和对水化的耐受性。这项前瞻性、多中心、随机对照、开放标签研究评估了 Vigileo/FloTrac 系统指导下的强化水化策略预防急性心肌梗死（AMI）患者 CIN 的疗效。这项试验纳入了接受紧急 PCI 的 AMI 患者，并将其随机（1:1）分为接受 Vigileo/FloTrac 系统指导的强化水化（干预组）或常规水化（对照组）。干预组的 AMI 患者接受负荷剂量生理盐水，根据 Vigileo/FloTrac 指数的变化调整水化速度。主要终点是 CIN，定义为在紧急 PCI 后 72 小时内与基线相比血清肌酐升高>25%或>0.5mg/100ml。该试验在 ClinicalTrials.gov 注册（NCT04382313）。共有 344 例 AMI 患者入组并在本试验中进行了随机分组，Vigileo/FloTrac 指导水化组（n=173）和对照组（n=171）的基线特征，包括 CIN 的危险因素，两组之间均衡（均 P>0.05）。Vigileo/FloTrac 指导水化组的总水化量明显多于对照组（1910±600 比 440±90ml，P<0.001）。Vigileo/FloTrac 指导水化组的 CIN 发生率明显低于对照组（12.1%[21/173]比 22.2%[38/171]，P=0.013）。两组 PCI 后急性心力衰竭的发生率无显著差异（9.2%[16/173]比 7.6%[13/171]，P=0.583）。Vigileo/FloTrac 指导水化组的主要不良心血管事件发生率低于对照组，但无统计学差异（30 例事件[17.3%]比 38 例事件[22.2%]，P=0.256）。总之，Vigileo/FloTrac 系统指导下的强化水化可有效降低 AMI 患者接受紧急 PCI 的 CIN 风险，同时避免急性心力衰竭发作。
