ORIGINAL ARTICLE   

Minerva Cardioangiologica 2019 October;67(5):380-91

DOI: 10.23736/S0026-4725.19.04925-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Routine iso-osmolar contrast media use and acute kidney injury following percutaneous coronary intervention for ST elevation myocardial infarction

Diluka PREMAWARDHANA ¹, Baskar SEKAR ¹, Muhammed Z. UL-HAQ ¹, Azeem SHEIKH ¹, Sean GALLAGHER ¹, Richard ANDERSON ¹, Samuel COPT ², Nick OSSEI-GERNING ¹, Tim KINNAIRD ¹ ✉

¹ Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, UK; ² Biosensors SA, Morges, Switzerland

BACKGROUND: Temporal changes in contrast-induced acute kidney injury (CI-AKI) incidence following primary percutaneous coronary intervention (PPCI) are poorly defined. Additionally, the benefits of iso-osmolar contrast media (IOCM) compared to low osmolar CM (LOCM) are uncertain.
METHODS: Using data from a regional PPCI service, temporal changes in baseline risk and annual incidence of CI-AKI were studied. A CM protocol change occurred in 2013 allowing a comparison of the incidence of CI-AKI between LOCM (2012-13) and IOCM (2013-15).
RESULTS: Between 2012 and 2015, 208 of 1310 patients experienced CI-AKI (15.9%). The Mehran AKI risk score did not change during the study period although there was an increase in the incidence of CI-AKI in later study years (P<0.001 for trend) when IOCM was used. Factors independently associated with CI-AKI were IOCM use (OR=1.96, [95% CI: 1.39-2.75]), age per year (OR=1.02, 95% CI: 1.01-1.04), baseline creatinine per µmol/L (OR=1.006, 95% CI: 1.003-1.01) and contrast volume per milliliter (OR=1.002, 95% CI: 1.001-1.004). The baseline characteristics of patients treated using IOCM (N.=783) vs. LOCM (N.=527) were similar (Mehran Score 6.6 vs. 6.9, P=0.173) but CI-AKI occurred more frequently with IOCM compared to LOCM (19.2% vs. 11.2%, P<0.001). Use of IOCM was independently associated with CI-AKI (OR=1.98, 95% CI: 1.339-2.774, P<0.001) with consistency across all sub-groups of age, gender, baseline creatinine, contrast volume, shock and diabetes. The adjusted in-hospital mortality was increased with IOCM compared to LOCM (OR=3.03, 95% CI: 1.313-6.994, P=0.009).
CONCLUSIONS: IOCM use was observed to be associated with an increased occurrence of CI-AKI, and an increase in in-hospital mortality after primary PCI.

KEY WORDS: Acute kidney injury; Percutaneous coronary intervention; Contrast media; Osmolar concentration