Predictors of contrast-induced acute kidney injury in hemodynamically stable patients with myocardial infarction

Abstract

The aim. To study predictors of contrast-induced acute kidney injury (CI-AKI) in hemodynamically stable patients with myocardial infarction (MI).Materials and methods. 487 hemodynamically stable patients with MI were under observation after emergency percutaneous coronary intervention (PCI). CI-AKI was defined as an increase in the level of creatinine in the blood within 48 hours after administration of the radiopaque drug (RCP) by ≥ 26.5 mmol from the baseline level. To detect independent risk factors of CI-AKI, the method of multiple logistic regression was used.Results. The observation group consisted of 48 patients with MI who developed CI-AKI (mean age 64.2 ± 5.18 years), the comparison group of 439 patients with MI without CI-AKI (mean age 55.6 ± 6.03 years). In the observation group were observed more often patients older than 70 years (13 [27.1 %] vs 29 [13.4 %]; p = 0.011), with arterial hypertension (45 [93.8 %] vs 329 [74.9 %]; p = 0.003), postinfarction cardiosclerosis (18 [37.5 %] vs 98 [22.3 %]; p = 0.019), glycemic level ≥ 6.1 mmol/l at admission (22 [45.8 %] vs 129 [29.4 %]; p = 0.019) and left ventricular ejection fraction ≤ 40 % (14 [29.2 %] vs 71 [16.2 %]; p = 0.024). In patients with CI-AKI, the frequency of three vascular pathologies of the coronary bed was higher (29 [60.4 %] vs 195 [44.4 %]; p = 0.035), two or more stents were implanted more often in PCI (31 [64.6 %] vs 184 [41.9 %]; p = 0.003) and the volume of сontrast volume ≥ 145 ml was used (30 [62.5 %] vs 206 [46.9 %]; p = 0.040).Findings. The probability of CI-AKI in hemodynamically stable MI patients was associated with the level of glucose in venous blood at admission ≥ 6.1 mmol/l, the сontrast volume used ≥ 145 ml and implantation of two or more stents in emergency PCI.