Korean Circ J.  2010 Feb;40(2):68-73. 10.4070/kcj.2010.40.2.68.

Periprocedural Hemoglobin Drop and Contrast-Induced Nephropathy in Percutaneous Coronary Intervention Patients

• Lee KH
• Lee SR
• Kang KP
• Kim HJ
• Lee SH
• Rhee KS
• Chae JK
• Kim WH
• Ko JK

• KMID: 2297941
• DOI: http://doi.org/10.4070/kcj.2010.40.2.68

Abstract

BACKGROUND AND OBJECTIVES
The development of contrast-induced nephropathy (CIN) is associated with an increased risk of death and late cardiovascular events after percutaneous coronary intervention (PCI). The relationship between CIN and hemoglobin drop has been controversial. The aim of this study was to evaluate the clinical usefulness of periprocedural hemoglobin drop as a nontraditional risk factor for CIN.
SUBJECTS AND METHODS
Five-hundred thirty-seven patients who underwent PCI were divided into 2 groups: Group I (486 patients: patients who did not develop CIN) and Group II (51 patients: patients who developed CIN). All patients were administered iodixanol as contrast media during coronary angiography. CIN is defined as a rise in serum creatinine of > or =25% or > or =0.5 mg/dL above the baseline value within 48 hours after contrast administration.
RESULTS
Baseline clinical and cardiovascular risk factors were not significantly different between the two groups, except for low abdominal circumference (Group I : Group II=87.9+/-9.0 cm : 81.2+/-15.1 cm, p=0.024), body weight (Group I : Group II=63.5+/-10.6 kg : 59.7+/-9.2 kg, p=0.008), body mass index (BMI) (Group I : Group II=24.4+/-3.4 kg/m2 : 23.4+/-2.8 kg/m2, p=0.032), pre-PCI hemoglobin (Group I : Group II=13.2+/-2.0 g/dL : 12.3+/-2.0 g/dL, p=0.003), and post-PCI hemoglobin (Group I : Group II=12.4+/-1.9 g/dL : 11.5+/-1.8 g/dL, p=0.001). Multiple logistic regression analysis showed that a periprocedural drop in hemoglobin (>1 g/dL) was an independent predictor of CIN, like other known risk factors.
CONCLUSION
A periprocedural drop in hemoglobin of more than 1 g/dL is another important independent predictor for CIN, even in patients administered the lowest nephrotoxic contrast agent, iodixanol, during PCI.

Keyword

Hemoglobin; Anemia; Contrast media; Renal insufficiency

MeSH Terms

Anemia
Body Mass Index
Body Weight
Contrast Media
Coronary Angiography
Creatinine
Hemoglobins
Humans
Logistic Models
Percutaneous Coronary Intervention
Renal Insufficiency
Risk Factors
Triiodobenzoic Acids
Contrast Media
Creatinine
Hemoglobins
Triiodobenzoic Acids

Figure

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  Fig. 1 There was a significant difference in the proportion of patients with a drop in hemoglobin (>1 g/dL). There was higher proportion of patients with an drop in hemoglobin among patients who developed CIN. CIN: contrast-induced nephropathy.

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