Abstract
Slight elevations in cardiac troponin I and T are frequently observed after percutaneous coronary intervention (PCI). Contrast-induced acute kidney injury (CI-AKI) is a complex syndrome induced by exposure to intravascular contrast media (CM). Currently, the relationships between the CM, pre-existing kidney insufficiency, CI-AKI, and myonecrosis after elective PCI are unclear. To investigate the relationship between CI-AKI and post-procedural myonecrosis (PMN) after PCI, we analyzed 327 non-ST-segment elevation acute coronary syndrome subjects undertaking elective PCI. The levels of cardiac troponins (cTns), cTnI and cTnT, at baseline and on at least one occasion 18–24 h after PCI were measured. We also recorded serum levels of creatinine (SCr) and the urine albumin:creatinine ratio (ACR) before coronary angiography, and 24–48 h and 48–72 h after contrast administration. A post-procedure increase in cTns was detected in 16.21% (53/327) of subjects with cTns levels >99th to 599th percentile upper reference limit (URL). Twenty-seven patients (8.26%) developed CI-AKI. CI-AKI occurred more often in subjects with PMN than in those without PMN (20.8% versus 5.8%, respectively, P=0.001). Multiple logistic regression analysis revealed that pre-existing microalbuminuria (MA) was an important independent predictor of PMN (OR: 3.31; 95% CI: 1.26–8.65, P=0.01). However, there was no correlation between the incidence of CI-AKI and PMN (OR: 2.38; 95% CI: 0.88–6.46, P=0.09). We conclude that pre-existing MA was not only an important independent predictor of CI-AKI but also of PMN.
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Project supported by the National Natural Science Foundation of China (No. 81170102/H0203), the Priority Academic Program Development of Jiangsu Higher Education Institutions (No. BL2012011), the Chinese Medical Association of the Sunlight Foundation (No. SCRFCMDA201217), and the Fourth Period Progect “333” of Jiangsu Province (No. BRA2012207), China
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Zhang, M., Meng, Hy., Zhao, Ym. et al. A correlation between acute kidney injury and myonecrosis after scheduled percutaneous coronary intervention. J. Zhejiang Univ. Sci. B 14, 713–720 (2013). https://doi.org/10.1631/jzus.BQICC706
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DOI: https://doi.org/10.1631/jzus.BQICC706
Key words
- Percutaneous coronary intervention
- Myonecrosis
- Contrast-induced nephropathy
- Acute kidney injury
- Contrast media