Nusca Annunziata, Di Bitonto Maria Pia, Spanò Agostino, Bernardini Federico, Mangiacapra Fabio, Ricottini Elisabetta, Melfi Rosetta, Giannone Sara, Ussia Gian Paolo, Grigioni Francesco
Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.
Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.
Am J Cardiol. 2025 Apr 1;240:50-56. doi: 10.1016/j.amjcard.2025.01.007. Epub 2025 Jan 11.
Contrast-associated acute kidney injury (CA-AKI) remains a serious complication after percutaneous coronary revascularization (PCI), with limited effective preventive strategies especially for diabetic patients. This study aimed to assess the effects of novel antidiabetic agents (NAD), i.e., glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium-glucose transporter-2 inhibitors (SGLT2i), and dipeptidyl peptidase-4 inhibitors (DPP4i), on the occurrence of this outcome in diabetic patients undergoing PCI. We enrolled 293 consecutive diabetic patients receiving NAD at the time of PCI (NAD group) and paired them with 293 diabetic individuals undergoing revascularization who were not on NAD (no-NAD group), matched according to age and sex. CA-AKI was defined as an increase in serum creatinine (SCr) ≥0.3 mg/dl or >50% from baseline within 48 to 72 hours after contrast exposure. A propensity score-adjusted logistic regression analysis was performed to account for potential selection bias. NAD treatment was associated with a significantly reduced incidence of CA-AKI than standard glucose-lowering therapies (4.1 vs. 8.5%, p = 0.023). Furthermore, patients using SGLT2i and GLP-1RAs exhibited a lower incidence of CA-AKI compared to those taking DPP4i. Both multivariate and propensity-score-adjusted regression analyses identified NAD therapy as an independent predictor of CA-AKI (OR 0.45, 95% CI 0.22-0.98, p = 0.040 and OR 0.48, 95% CI 0.23-0.98, p = 0.045). In conclusion, this study is the first to explore the potential benefit of all three NAD classes on CA-AKI incidence. The use of these agents is associated with a lower incidence of renal damage in diabetic patients undergoing PCI, with the greatest benefit observed with SGLT2i and GLP-1RAs use.
造影剂相关急性肾损伤（CA-AKI）仍是经皮冠状动脉血运重建术（PCI）后一种严重的并发症，有效的预防策略有限，尤其是对于糖尿病患者。本研究旨在评估新型抗糖尿病药物（NAD），即胰高血糖素样肽-1受体激动剂（GLP-1RAs）、钠-葡萄糖协同转运蛋白-2抑制剂（SGLT2i）和二肽基肽酶-4抑制剂（DPP4i），对接受PCI的糖尿病患者发生这一结局的影响。我们纳入了293例在PCI时接受NAD治疗的连续糖尿病患者（NAD组），并将他们与293例未接受NAD治疗的接受血运重建术的糖尿病个体（非NAD组）进行配对，根据年龄和性别进行匹配。CA-AKI定义为在造影剂暴露后48至72小时内血清肌酐（SCr）较基线水平升高≥0.3mg/dl或升高>50%。进行倾向评分调整的逻辑回归分析以考虑潜在的选择偏倚。与标准降糖治疗相比，NAD治疗与CA-AKI的发生率显著降低相关（4.1%对8.5%，p = 0.023）。此外，与服用DPP4i的患者相比，使用SGLT2i和GLP-1RAs的患者CA-AKI的发生率较低。多因素和倾向评分调整回归分析均将NAD治疗确定为CA-AKI的独立预测因素（OR 0.45，95%CI 0.22-0.98，p = 0.040；OR 0.48，95%CI 0.23-0.98，p = 0.045）。总之，本研究首次探讨了所有三类NAD对CA-AKI发生率的潜在益处。在接受PCI的糖尿病患者中，使用这些药物与较低的肾损伤发生率相关，使用SGLT2i和GLP-1RAs时观察到的益处最大。
