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Abstract
C
ontrast-induced nephropathy is a potentially avoidable complication caused during procedures involving the use of radiographic contrast media, All subjects, especially at high risk should be subjected to available preventive protocols prior to and after such procedures.
The current study included 100 patients presented to the emergency room of Ain Shams university hospitals and the National Heart Institute with acute ST-segment elevation myocardial infarction and were treated with either primary or rescue PCI.
The current study was aiming to determine the incidence of contrast-induced nephropathy (CIN) and its prognostic impact in this group of patients.
All the patients were subjected to full history taking with special emphasis on the known predisposing factors for CIN, thorough clinical examination, Primary or Rescue PCI (if reperfusion was not clearly evident 90 minutes after initation of lytic therapy) were performed by a 24-hours on-call interventional team according to standard clinical practice, an echocardiographic evaluation was done to all patients, serum creatinine was measured at the time of admission (just before primary or rescue PCI), every day for the following three days in the CCU and after one and two weeks of hospital admission.
The study population was divided into two groups, the first in whom CIN had occurred while the second in whom CIN had not occurred.
The current study found that contrast-induced nephropathy had occurred in three cases (3%) among the study population, and of those patients only one patient required hemodialysis.
The current study found no significant differences between both groups regarding sex, incidence of diabetes mellitus, pre-existing renal impairment, age > 65 years, congestive heart failure, cardiogenic shock and dye type, But there was statistically significant difference between both groups regarding the amount of dye and the age distribution of the patients.
It was concluded from the current study that the volume of contrast medium is a main modifiable risk factor in the development of CIN, as contrast volume increases, the risk of developing CIN sharply increases especially in patients at risk for acute renal injury,
The mechanisms by which CIN worsens outcomes in patients undergoing primary PCI are multi-factorial. Patients with CIN were more often elderly and were more likely to have a reduced left ventricular EF. Also elevated baseline level of serum creatinine is a crucial risk factor in the development of CIN.