Association between high sensitivity C-reactive protein and contrast induced acute kidney Injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention: impact of atorvastatin
10.3760/cma.j.issn.0253-3758.2011.09.007
- VernacularTitle:高敏C反应蛋白水平与阿托伐他汀对急性冠状动脉综合征患者对比剂所致肾功能损害影响的关系
- Author:
Jin-Zi SU
1
;
Yan XUE
;
Wen-Qin CAI
;
Qun-Ying HUANG
;
Da-Jun CHAI
;
Guang-Ling CHEN
;
Fang-Bing WANG
;
Xiu-Ping CHEN
;
Du-Sheng ZHANG
Author Information
1. 福建医科大学附属第一医院
- Keywords:
Coronary disease;
Antilipemic agents;
Angioplasty,transluminal,percutaneous coronary;
Contrast media;
Renal insufficiency
- From:
Chinese Journal of Cardiology
2011;39(9):807-811
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe the association between preprocedural high sensitivity C-reactive protein (hs-CRP) level and incidence of contrast induced acute kidney injury (CI-AKI) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) and the impact of atorvastatin pretreatment on CI-AKI. Methods According to the level of preprocedural hs-CRP, 270 ACS patients were divided into three groups: high hs-CRP group (hs-CRP≥3 mg/L, n =176), moderate hsCRP group (hs-CRP 1 -3 mg/L, n =60) and normal hs-CRP group ( hs-CRP ＜ 1 mg/L, n =34).According to the dosage of preprocedural atorvastatin, the high hs-CRP group was further divided into 10 mg group (n =49), 20 mg group (n =66) and 40 mg group (n =61 ). Serum creatinine (Ser), blood urea nitrogen (BUN), cystatin C (Cys C), hs-CRP were measured at before and 24 hours, 48 hours after PCI.CCr and GFR were calculated according to Scr and Cys C. Risk factors for CI-AKI were determined by multivariate logistic regression analysis. Results ( 1 ) Cys C was significantly increased and GFR after PCI significantly reduced in high and moderate hs-CRP groups compared with normal hs-CRP group ( P ＜ 0. 05 ).(2) Incidence of CI-AKI was 43. 18％, 38. 33％ , 20. 59％ in high, moderate and normal hs-CRP groups,respectively (P ＜ 0. 05 ). (3) In high hs-CRP group, postprocedural GFR was significantly higher while postprocedural Cys C and hs-CRP were significantly lower in 40 mg statin subgroup than 10 mg and 20 mg statin subgroups (P ＜ 0. 05), similar trends were documented when comparing 20 mg statin subgroup with 10 mg statin subgroup ( P ＜ 0. 05 ). (4) Multivariate logistic regression analysis showed that pretreatment with high dose atorvastatin was a protective factor for post CI-AKI (20 mg atorvastatin: OR =0. 15, 95％ CI 0. 06 -0. 33, P =0. 00 1 ; 40 mg atorvastatin: OR =0. 10, 95 ％ CI 0. 04 -0. 23, P =0. 001 ), while high levels of preprocedural hs-CRP (OR =2. 06, 95％ CI 1.01 -4. 23, P =0. 048), diabetes mellitus (OR =10.71,95％ CI5.29 -21.70, P=0.001), advanced age (OR =2. 64, 95％ CI 1.05 -6. 63, P =0.038)and renal failure ( OR =5. 14, 95％ CI 1.13 - 23.39, P =0. 034 ) were independent risk factors of CIAKI. Conclusion High hs-CRP level is linked with the development of CI-AKI in ACS patients undergoing PCI and pretreatment with 40 mg atorvastatin is associated with lower incidence CI-AKI, possibly by reducing the postprocedural inflammation responses.
