Effects of contrast-induced nephropathy and perioperative myocardial injury on short-term prognosis in patients after percutaneous coronary intervention
10.3760/cma.j.cn114015-20201230-01298
- VernacularTitle:对比剂肾病和围手术期心肌损伤对经皮冠状动脉介入术后患者近期预后的影响
- Author:
Yulong LI
1
;
Shaopan ZHAO
;
Shihui FU
;
Leiming LUO
Author Information
1. 中国人民解放军医学院，北京 100853
- Publication Type:Journal Article
- Keywords:
Acute coronary syndrome;
Percutaneous coronary intervention;
Troponin T;
Prognosis;
Contrast-induced nephropathy;
Perioperative myocardial injury
- From:
Adverse Drug Reactions Journal
2021;23(4):178-183
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effects of contrast-induced nephropathy (CIN) and/or perioperative myocardial injury (PMI) on the short-term prognosis of patients after percutaneous coronary intervention (PCI).Method:The study was designed as a prospective cohort study. The subjects were selected from patients with acute coronary syndrome (ACS) who underwent PCI in the Department of Cardiology, the First Medical Center, General Hospital of Chinese people′s Liberation Army from August to October 2015. According to the occurrence of CIN and PMI after operation, the patients were divided into 4 groups: no injury group, CIN group, PMI group, and CIN+PMI group. The patients were followed up for 12 months, and the end point was the main adverse cardiovascular events (MACE). The differences in basic characteristics (sex, age, ACS type, underlying diseases, past medical history, etc.), the preoperative levels of serum creatinine, triglyceride, low density lipoprotein cholesterol, fasting blood glucose, high sensitivity troponin T (hs-cTnT), creatine kinase (CK) MB, C-reactive protein, and N terminal pro-B type natriuretic peptide (NT-proBNP), levels of serum creatinine, hs-cTnT, CK-MB, and NT-proBNP within 48 hours after operation, and the occurrence of MACE were compared in patients among the 4 groups. The effects of CIN and/or PMI on the occurrence of MACE within 12 months after operation were analyzed using COX multivariate regression model.Results:A total of 299 patients were included in the cohort study, including 216 males (72.2%) and 83 females (27.8%), with an average age of 60 years (range, 26-84 years). Of them, 125 patients (41.8%) were with ST segment elevation myocardial infarction (STEMI). One hundred and eighty-two patients (60.9%), 18 patients (6.0%), 79 patients (26.4%), and 20 patients (6.7%) were included in the non-injury group, CIN group, PMI group, and CIN+PMI group, respectively. The incidence of CIN in all patients was 12.7% (38/299) and that of PMI was 33.1% (99/299). No subjects were lost during the 12-month follow-up. Of the 299 patients, 24 subjects had 26 times of MACE [cardiogenic death, nonfatal myocardial infarction (NF-MI), target vessel revascularization (TVR), and stroke occurred 3, 5, 5, and 13 times, respectively] and the incidence of MACE was 8.0%. The incidences of MACE in the no injury group, CIN group, PMI group, and CIN+PMI group were 1.6% (3/182), 11.1% (2/18), 11.4% (9/79), and 50.0% (10/20), respectively, and the difference among groups was statistically significant ( P<0.001). The results of COX multivariate regression analysis showed increased risk of MACE in the other 3 groups [hazard risk ( HR)=6.897, 95%confidence interval ( CI): 1.152-41.281, P=0.034; HR=7.623,95 %CI: 2.063-28.167, P=0.002; HR=43.087, 95 %CI: 11.817-157.098, P<0.001) compared with the non-injury group. Conclusion:Both CIN and PMI can increase the risk of MACE in patients within 12 months after PCI treatment, which can be further increased in the coexistence of them.
