Korean J Med.  2012 Feb;82(2):185-193.

Predictors of Contrast-Induced Nephropathy in Acute Coronary Syndrome Patients with Renal Dysfunction

• Park SH
• Jeong MH
• Rhee JA
• Choi JS
• Hwang SH
• Ko JS
• Lee MG
• Sim DS
• Park KH
• Yoon NS
• Yoon HJ
• Kim KH
• Hong YJ
• Kim JH
• Ahn Y
• Cho JG
• Park JC
• Kang JC

Abstract

BACKGROUND/AIMS
Contrast-induced nephropathy (CIN) is an important complication of diagnostic coronary angiography (CAG) and percutaneous coronary intervention (PCI). We investigated the incidence and predictors of the development of CIN in acute coronary syndrome (ACS) patients with renal dysfunction undergoing PCI.
METHODS
From January 2005 to June 2010, we evaluated the clinical, laboratory, and angiographic data of 406 patients with ACS who had a serum creatinine > or = 1.3 mg/dL and underwent CAG or PCI. The patients were divided into two groups according to the development of CIN (CIN, n = 92; no CIN, n = 314).
RESULTS
Of the 406 patients, 92 (22.7%) developed CIN. The development of CIN was associated with a lower baseline body mass index (p = 0.001), decreased left ventricular ejection fraction (LVEF) (p < 0.001), decreased creatinine clearance (CrCl) (p < 0.001), lower albumin (p < 0.001), lower hemoglobin (p = 0.003), higher N-terminal pro B type natriuretic peptide (p = 0.001), and greater contrast medium volume (CMV) (p = 0.021). On multiple logistic regression analysis, LVEF < 40% (OR, 4.080; 95% CI, 2.087-7.977; p < 0.001), albumin < 3.5 g/dL (OR, 2.042; 95% CI, 1.211-3.440; p = 0.007), and CMV/CrCl > or = 3.5 (OR, 1.964; 95% CI, 1.243-3.101; p = 0.004) were independent predictors of CIN. The cut-off value for CMV/CrCl was 3.5, and that for albumin was 3.55 g/dL.
CONCLUSIONS
CIN occurred in 22.7% of the patients with ACS and renal dysfunction who underwent CAG or PCI. Independent predictors of CIN were decreased LVEF, decreased albumin, and increased CMV/CrCl ratio.

Keyword

Contrast-induced nephropathy; Acute coronary syndrome; Renal dysfunction

MeSH Terms

Acute Coronary Syndrome
Body Mass Index
Coronary Angiography
Creatinine
Hemoglobins
Humans
Incidence
Logistic Models
Percutaneous Coronary Intervention
Stroke Volume
Creatinine
Hemoglobins