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Combined impact of chronic kidney disease and contrast-induced nephropathy on long-term outcomes in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention

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Abstract

Contrast-induced nephropathy (CIN) and chronic kidney disease (CKD) are associated with poor outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI); however, its combined prognostic significance remains unclear. We enrolled 577 patients with AMI undergoing primary PCI within 12 h after symptom onset and measured serum creatinine on admission and the next 3 days. CKD was defined as admission estimated glomerular filtration rate <60 ml/min/1.73 m2, and CIN was defined as creatinine increase ≥0.5 mg/dl or ≥25 % from baseline within the first 72 h. Patients were stratified according to the presence or absence of CKD and CIN. In patients with no CKD and no CIN (n = 244), no CKD but CIN (n = 152), CKD but no CIN (n = 127), and both CKD and CIN (n = 54), the 3-year major adverse cardiovascular events (MACE: a combination of all-cause mortality, nonfatal reinfarction, or heart failure requiring rehospitalization) were 8, 9, 13, and 35 %, respectively (p < 0.001). Multivariate analysis showed that as compared with no CKD and no CIN, hazard ratios (95 % CI) for MACE associated with no CKD but CIN, CKD but no CIN, and both CKD and CIN were 0.91 (0.44–1.84; p = 0.79), 1.11 (0.5–2.23; p = 0.77), and 2.98 (1.48–6.04; p = 0.002), respectively. In patients with AMI undergoing primary PCI, the combination of CKD and CIN is significantly associated with adverse long-term outcomes.

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References

  1. O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW (2013) 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 61:e78–e140

    Article  PubMed  Google Scholar 

  2. Narula A, Mehran R, Weisz G, Dangas GD, Yu J, Généreux P, Nikolsky E, Brener SJ, Witzenbichler B, Guagliumi G, Clark AE, Fahy M, Xu K, Brodie BR, Stone GW (2014) Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy. Eur Heart J 35:1533–1540

    Article  CAS  PubMed  Google Scholar 

  3. Marenzi G, Lauri G, Assanelli E, Campodonico J, De Metrio M, Marana I, Grazi M, Veglia F, Bartorelli AL (2004) Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 44:1780–1785

    Article  PubMed  Google Scholar 

  4. Chong E, Poh KK, Liang S, Soon CY, Tan HC (2010) Comparison of risks and clinical predictors of contrast-induced nephropathy in patients undergoing emergency versus nonemergency percutaneous coronary interventions. J Interv Cardiol 23:451–459

    Article  PubMed  Google Scholar 

  5. Abe D, Sato A, Hoshi T, Kakefuda Y, Watabe H, Ojima E, Hiraya D, Harunari T, Takeyasu N, Aonuma K (2014) Clinical predictors of contrast-induced acute kidney injury in patients undergoing emergency versus elective percutaneous coronary intervention. Circ J 78:85–91

    Article  CAS  PubMed  Google Scholar 

  6. Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, Mintz GS, Lansky AJ, Moses JW, Stone GW, Leon MB, Dangas G (2004) A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 44:1393–1399

    PubMed  Google Scholar 

  7. Wright RS, Reeder GS, Herzog CA, Albright RC, Williams BA, Dvorak DL, Miller WL, Murphy JG, Kopecky SL, Jaffe AS (2002) Acute myocardial infarction and renal dysfunction: a high-risk combination. Ann Intern Med 137:563–570

    Article  PubMed  Google Scholar 

  8. Sadeghi HM, Stone GW, Grines CL, Mehran R, Dixon SR, Lansky AJ, Fahy M, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Stuckey TD, Turco M, Carroll JD (2003) Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction. Circulation 108:2769–2775

    Article  PubMed  Google Scholar 

  9. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A (2009) Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53:982–992

    Article  CAS  PubMed  Google Scholar 

  10. National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266

    Google Scholar 

  11. McCullough PA (2008) Contrast-induced acute kidney injury. J Am Coll Cardiol 51:1419–1428

    Article  PubMed  Google Scholar 

  12. Cigarroa RG, Lange RA, Williams RH, Hillis LD (1989) Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med 86:649–652

    Article  CAS  PubMed  Google Scholar 

  13. Marenzi G, Assanelli E, Campodonico J, Lauri G, Marana I, De Metrio M, Moltrasio M, Grazi M, Rubino M, Veglia F, Fabbiocchi F, Bartorelli AL (2009) Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality. Ann Internal Med 150:170–177

    Article  Google Scholar 

  14. Mehta RH, Harjai KJ, Cox D, Stone GW, Brodie B, Boura J, O’Neill W, Grines CL (2003) Clinical and angiographic correlates and outcomes of suboptimal coronary flow in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. J Am Coll Cardiol 42:1739–1746

    Article  PubMed  Google Scholar 

  15. Becker RC, Burns M, Gore JM, Spencer FA, Ball SP, French W, Lambrew C, Bowlby L, Hilbe J, Rogers WJ (1998) Early assessment and in-hospital management of patients with acute myocardial infarction at increased risk for adverse outcomes: a nationwide perspective of current clinical practice. The National Registry of Myocardial Infarction (NRMI-2) Participants. Am Heart J 135:786–796

    Article  CAS  PubMed  Google Scholar 

  16. Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E, Cox DA, Turco M, Stuckey TD, Na Y, Lansky AJ, Gersh BJ, O’Neill WW, Mehran R, Stone GW (2005) Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score. J Am Coll Cardiol 45:1397–1405

    Article  PubMed  Google Scholar 

  17. **ng K, Fu X, Wang Y, Li W, Gu X, Hao G, Miao Q, Li S, Jiang Y, Fan W, Geng W (2015) Effect of rhBNP on renal function in STEMI-HF patients with mild renal insufficiency undergoing primary PCI. Heart Vessels. doi:10.1007/s00380-015-0642-8

    PubMed  Google Scholar 

  18. Gurm HS, Dixon SR, Smith DE, Share D, Lalonde T, Greenbaum A (2011) Renal function-based contrast dosing to define safe limits of radiographic contrast media in patients undergoing percutaneous coronary interventions. J Am Coll Cardiol 58:907–914

    Article  PubMed  Google Scholar 

  19. Wi J, Ko YG, Kim JS, Kim BK, Choi D, Ha JW, Hong MK, Jang Y (2011) Impact of contrast-induced acute kidney injury with transient or persistent renal dysfunction on long-term outcomes of patients with acute myocardial infarction undergoing percutaneous coronary intervention. Heart 97:1753–1757

    Article  PubMed  Google Scholar 

  20. Oduncu V, Erkol A, Karabay CY, Şengül C, Tanalp AC, Fotbolcu H, Özveren O, Bitigen A, Pala S, Kırma C (2013) Relation of the severity of contrast induced nephropathy to SYNTAX score and long term prognosis in patients treated with primary percutaneous coronary intervention. Int J Cardiol 168:3480–3485

    Article  PubMed  Google Scholar 

  21. Goussot S, Mousson C, Guenancia C, Stamboul K, Brunel P, Brunet D, Touzery C, Cottin Y, Zeller M (2015) N-terminal fragment of pro B-type natriuretic peptide as a marker of contrast-induced nephropathy after primary percutaneous coronary intervention for st-segment elevation myocardial infarction. Am J Cardiol 116:865–871

    Article  CAS  PubMed  Google Scholar 

  22. Dangas G, Iakovou I, Nikolsky E, Aymong ED, Mintz GS, Kipshidze NN, Lansky AJ, Moussa I, Stone GW, Moses JW, Leon MB, Mehran R (2005) Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol 95:13–19

    Article  PubMed  Google Scholar 

  23. Seeliger E, Sendeski M, Rihal CS, Persson PB (2012) Contrast-induced kidney injury: mechanisms, risk factors, and prevention. Eur Heart J 33:2007–2015

    Article  PubMed  Google Scholar 

  24. Shacham Y, Leshem-Rubinow E, Gal-Oz A, Arbel Y, Keren G, Roth A, Steinvil A (2015) Acute cardio-renal syndrome as a cause for renal deterioration among myocardial infarction patients treated with primary percutaneous intervention. Can J Cardiol 31:1240–1244

    Article  PubMed  Google Scholar 

  25. Sanborn TA, Sleeper LA, Webb JG, French JK, Bergman G, Parikh M, Wong SC, Boland J, Pfisterer M, Slater JN, Sharma S, Hochman JS (2003) Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial. J Am Coll Cardiol 42:1373–1379

    Article  PubMed  Google Scholar 

  26. Anderson JL, Karagounis LA, Califf RM (1996) Metaanalysis of five reported studies on the relation of early coronary patency grades with mortality and outcomes after acute myocardial infarction. Am J Cardiol 78:1–8

    Article  CAS  PubMed  Google Scholar 

  27. Miyachi H, Takagi A, Miyauchi K, Yamasaki M, Tanaka H, Yoshikawa M, Saji M, Suzuki M, Yamamoto T, Shimizu W, Nagao K, Takayama M (2016) Current characteristics and management of ST elevation and non-ST elevation myocardial infarction in the Tokyo metropolitan area: from the Tokyo CCU network registered cohort. Heart Vessels. doi:10.1007/s00380-015-0791-9

    PubMed  PubMed Central  Google Scholar 

  28. Fox CS, Muntner P, Chen AY, Alexander KP, Roe MT, Cannon CP, Saucedo JF, Kontos MC, Wiviott SD (2010) Use of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: a report from the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network registry. Circulation 121:357–365

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Anzai A, Maekawa Y, Kodaira M, Mogi S, Arai T, Kawakami T, Kanazawa H, Hayashida K, Yuasa S, Kawamura A, Fukuda K (2015) Prognostic implications of optimal medical therapy in patients undergoing percutaneous coronary intervention for acute coronary syndrome in octogenarians. Heart Vessels 30:186–192

    Article  PubMed  Google Scholar 

  30. Wong PC, Li Z, Guo J, Zhang A (2012) Pathophysiology of contrast-induced nephropathy. Int J Cardiol 158:186–192

    Article  PubMed  Google Scholar 

  31. Tan J, Hua Q, Li J, Fan Z (2009) Prognostic value of interleukin-6 during a 3-year follow-up in patients with acute ST-segment elevation myocardial infarction. Heart Vessels 24:329–334

    Article  PubMed  Google Scholar 

  32. Russo D, Minutolo R, Cianciaruso B, Memoli B, Conte G, De Nicola L (1995) Early effects of contrast media on renal hemodynamics and tubular function in chronic renal failure. J Am Soc Nephrol 6:1451–1458

    CAS  PubMed  Google Scholar 

  33. Budano C, Levis M, D’Amico M, Usmiani T, Fava A, Sbarra P, Burdese M, Segoloni GP, Colombo A, Marra S (2011) Impact of contrast-induced acute kidney injury definition on clinical outcomes. Am Heart J 161:963–971

    Article  PubMed  Google Scholar 

  34. Oduncu V, Erkol A, Karabay CY, Şengül C, Tanalp AC, Fotbolcu H, Özveren O, Bitigen A, Pala S, Kırma C (2013) Relation of the severity of contrast induced nephropathy to SYNTAX score and long term prognosis in patients treated with primary percutaneous coronary intervention. Int J Cardiol 168:3480–3485

    Article  PubMed  Google Scholar 

  35. Jarai R, Dangas G, Huber K, Xu K, Brodie BR, Witzenbichler B, Metzger DC, Radke PW, Yu J, Claessen BE, Genereux P, Mehran R, Stone GW (2012) B-type natriuretic peptide and risk of contrast-induced acute kidney injury in acute ST-segment-elevation myocardial infarction: a substudy from the HORIZONS-AMI trial. Circ Cardiovasc Interv 5:813–820

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan

    Hidefumi Nakahashi, Masami Kosuge, Toshiaki Ebina, Kiyoshi Hibi, Kengo Tsukahara, Noriaki Iwahashi, Shotaro Kuji & Kazuo Kimura

  2. Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Kentaro Sakamaki & Mari S. Oba

  3. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan

    Masayoshi Kiyokuni & Satoshi Umemura

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  1. Hidefumi Nakahashi
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Nakahashi, H., Kosuge, M., Sakamaki, K. et al. Combined impact of chronic kidney disease and contrast-induced nephropathy on long-term outcomes in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention. Heart Vessels 32, 22–29 (2017). https://doi.org/10.1007/s00380-016-0836-8

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