碘化造影剂短缺对造影剂相关急性肾损伤的影响：单中心经验
Impact of iodinated contrast shortage on contrast-associated acute kidney injury: a single center experience.
作者信息
Al-Azizi Karim M, Moubarak Ghadi, Szerlip Molly I, Kluis Austin, Kazem Ahmed, Bennett Monica M, Foster Lisa, Thomas Sibi, Dib Chadi, Sayfo Sameh, Varma Jai, Baig Imran, DiMaio J Michael, Mack Michael J, Potluri Srinivasa P
机构信息
Department of Cardiology, Baylor Scott & White The Heart Hospital, Plano, Texas, USA.
Baylor Scott & White Research Institute, Plano, Texas, USA.
出版信息
Proc (Bayl Univ Med Cent). 2024 Feb 8;37(2):218-226. doi: 10.1080/08998280.2023.2296692. eCollection 2024.
BACKGROUND
In March 2022, a COVID-19 outbreak disrupted the global supply of iodine contrast media (ICM). Healthcare systems implemented contrast-saving strategies to maintain their remaining ICM supplies. This study sought to determine the impact of contrast shortage on the incidence of contrast-associated acute kidney injury (CA-AKI).
METHODS
This was a retrospective study of 265 patients undergoing 278 percutaneous coronary interventions (PCI) during 4-month periods prior to (9/1/2021 to 12/31/2021) and during (5/1/2022 to 8/31/2022) contrast shortage at a single center. The primary endpoint was the incidence of CA-AKI between study periods.
RESULTS
A total of 148 and 130 PCIs were performed before and during contrast shortage, respectively. The incidence of CA-AKI significantly decreased from 11.5% to 4.6% during contrast shortage ( = 0.04). During the shortage, average contrast volume per PCI was significantly lower (123 ± 62 mL vs 88 ± 46 mL, < 0.001), while coronary imaging was significantly higher (34.3% vs 50%, = 0.009) compared to preshortage. All-cause mortality at discharge was comparable between study periods (2.8% vs 3.3%, respectively; = 0.90).
CONCLUSION
The scarcity of ICM for PCI procedures in this single-center experience was associated with a significant increase in the utilization of intravascular imaging and a significant reduction in CA-AKI.
背景
2022年3月，新型冠状病毒肺炎（COVID-19）疫情扰乱了碘造影剂（ICM）的全球供应。医疗系统实施了造影剂节约策略以维持其剩余的ICM供应。本研究旨在确定造影剂短缺对造影剂相关急性肾损伤（CA-AKI）发生率的影响。
方法
这是一项回顾性研究，对在单一中心造影剂短缺前（2021年9月1日至2021年12月31日）和期间（2022年5月1日至2022年8月31日）的4个月内接受278例经皮冠状动脉介入治疗（PCI）的265例患者进行研究。主要终点是研究期间CA-AKI的发生率。
结果
造影剂短缺前和期间分别进行了148例和130例PCI。造影剂短缺期间，CA-AKI的发生率从11.5%显著降至4.6%（P = 0.04）。在短缺期间，与短缺前相比，每次PCI的平均造影剂用量显著降低（123±62 mL对88±46 mL，P < 0.001），而冠状动脉成像显著增加（34.3%对50%，P = 0.009）。研究期间出院时的全因死亡率相当（分别为2.8%和3.3%；P = 0.90）。
结论
在这一单一中心的经验中，PCI手术中ICM的短缺与血管内成像利用率的显著增加和CA-AKI的显著降低相关。
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