Chen Zaiyan, Mao Qi, Xiang Li, Zhou Denglu, Jiang Yanbing, Zhao Ning, Huang Lan, Azzalini Lorenzo, Zhao Xiaohui
Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China.
Department of Cardiovascular Diseases, The General Hospital of Tibet Military Region, Lhasa, China.
Eur Radiol. 2023 Dec;33(12):9444-9454. doi: 10.1007/s00330-023-09964-8. Epub 2023 Jul 22.
To evaluate iodixanol-associated acute kidney injury (AKI) and prognosis in patients undergoing elective percutaneous coronary intervention (PCI).
Patients undergoing elective PCI and iodixanol administration were prospectively enrolled in 8 centers between May 2020 and November 2021. The primary endpoint was AKI, defined as an increase in SCr of ≥ 0.3 mg/dL (26.4 μmol/L) or relative elevation ≥ 50% from baseline in the 48-72 h after PCI. Prognosis evaluations included the major adverse renal and cardiovascular events (MARCE): all-cause mortality, new-onset renal replacement therapy (NRRT), non-fatal myocardial infarction, and non-fatal stroke. AKI predictors were identified using multivariable logistic regression and associations between AKI and outcomes were examined using Cox regression.
A total of 3630 patients were included in the final analysis and 2.9% of patients (107/3,630) suffered AKI. Among them, 95.3% (102/107) of AKI were stage 1, and 4.6% (5/107) of stage 2. The multivariable analysis indicated that age over 75-year-old, diabetes, NT-pro-BNP > 300 pg/mL, hemoglobin < 110 g/L, eGFR < 60 mL/min/1.73m, and diuretics were independently associated with AKI (p < 0.05). After a median follow-up of 13 months, MARCE occurred in 3.6% (131/3630) of the study population, and their incidence was higher in AKI (9.4%, 10/107) vs. non-AKI patients (3.4%, 121/3,523). However, after multivariable adjustment, there was no statistically significant association between AKI and MARCE (p = 0.382).
In patients undergoing elective PCI, cases of iodixanol-associated AKI were mostly mild and, after multivariable adjustment, held no statistically significant association with MARCE on mid-term follow-up.
The incidence of iodixanol-associated AKI was low and mainly limited to mild renal impairment in patients undergoing elective PCI. Physicians should provide adequate contrast for coronary artery evaluation and, at the same time, minimize the contrast volume.
• The incidence of iodixanol-associated acute kidney injury was low and mostly limited to mild renal impairment. • Iodixanol administration had no statistically significant impact on the major adverse renal and cardiovascular events in patients undergoing elective percutaneous coronary intervention.
评估接受择期经皮冠状动脉介入治疗（PCI）患者中碘克沙醇相关急性肾损伤（AKI）及预后情况。
2020年5月至2021年11月期间，8个中心前瞻性纳入了接受择期PCI并使用碘克沙醇的患者。主要终点为AKI，定义为PCI术后48 - 72小时内血清肌酐（SCr）升高≥0.3 mg/dL（26.4 μmol/L）或较基线相对升高≥50%。预后评估包括主要不良肾和心血管事件（MARCE）：全因死亡率、新发肾脏替代治疗（NRRT）、非致命性心肌梗死和非致命性卒中。使用多变量逻辑回归确定AKI的预测因素，并使用Cox回归检验AKI与结局之间的关联。
最终分析共纳入3630例患者，2.9%（107/3630）的患者发生AKI。其中，95.
