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Contrast induced nephropathy (CIN) has been reported in up to 19% of patients undergoing primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). A recent study showed that a hydration strategy based on left ventricular end diastolic pressure (LVEDP) decreased the incidence of CIN in patients undergoing PCI. Our study explores the relationship between LVEDP and the incidence CIN in patients with STEMI undergoing PCI.
Patients with STEMI who underwent emergent PCI at our hospital from 2005-2013 were retrospectively analyzed. The PCI and hydration strategies were at the discretion of the operator. CIN was defined as an increase in creatinine of more than 0.5mg/dL or 25% from baseline, within 72 hours post procedure. Patients were categorized into two groups according to LVEDP values measured at the time of cardiac catheterization: LVEDP ≥19 mmHg (n= 196), and LVEDP <19 mm Hg (n= 76). The clinical and procedural characteristics and incidence of CIN were compared between the 2 groups. Multivariate regression analysis was performed to evaluate for independent risk factors for CIN.
Out of 272 patients analyzed, a total of 48 patients (17.6%) developed CIN. Baseline creatinine levels, the prevalence of diabetes mellitus, and the incidence of anterior wall myocardial infarction were similar in CIN group and non-CIN group. Patients with LVEDP≥19 mmHg had statistically significant higher cardiac enzyme than patients with LVEDP<19. The incidence of CIN in patients with an LVEDP ≥19 mm Hg was 41 (21%) compared to 7 (9.2%) in patients with LVEDP < 19 mm Hg. This was statistically significant with a chi square statistic of 5.16 with p-value=0.02. A multivariate regression analysis was performed which showed that an LVEDP ≥19 mm Hg, as well as intra-aortic balloon pump use and age are independent predictors of CIN in our STEMI cohort.
In patients with STEMI who underwent emergent PCI, an elevated LVEDP at the time of catheterization was associated with increased incidence of CIN. An LVEDP ≥19 mm Hg portends a statistically significant higher risk for CIN in this population and hydration strategies may need to be adjusted accordingly.