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Safe contrast volumes for preventing contrast-induced nephropathy in elderly patients with relatively normal renal function during percutaneous coronary intervention.

Liu Y, Liu YH, Chen JY, Tan N, Zhou YL, Duan CY, Yu DQ, Xie NJ, Li HL, Chen PY - Medicine (Baltimore) (2015)

Bottom Line: Thirty-nine patients (3.8%) developed CIN.There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001).After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45-7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14-3.38, P = 0.016).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Cardiology (YL, J-yC, NT, Y-lZ, D-qY, N-jX, H-lL), Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences; Department of cardiology, Guangdong General Hospital, Southern Medical University (Y-hL); and Department of Biostatistics (C-yD, P-yC), School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China.

ABSTRACT
The aim of this study was to evaluate contrast media volume to creatinine clearance (V/CrCl) ratio for predicting contrast-induced nephropathy (CIN) and to determine a safe V/CrCl cut off value to avoid CIN in elderly patients with relatively normal renal function during percutaneous coronary intervention (PCI). We prospectively enrolled 1020 consecutive elderly patients (age ≥65 years) with relative normal renal function (baseline serum creatinine <1.5 mg/dL) undergoing PCI. Receiver operating characteristic (ROC) curves were used to identify the optimal cut off value of V/CrCl for detecting CIN. The predictive value of V/CrCl for CIN was assessed with a multivariate logistic regression. Thirty-nine patients (3.8%) developed CIN. There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001). ROC curve analysis indicated that a V/CrCl ratio of 2.74 was a fair discriminator for CIN (C statistic = 0.68). After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45-7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14-3.38, P = 0.016). A V/CrCl ratio >2.74 was a significant independent predictor of CIN and was independently associated with long-term mortality in elderly patients with relatively normal renal function.

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Multivariate Cox regression analysis indicates that a V/CrCl ratio >2.74 is significantly associated with an increased risk of death within 3 years follow-up after PCI. CI = confidence interval, CM = contrast media, DM = diabetes mellitus, HR = hazard ratio, IABP = intra-aortic balloon pump, LVEF = left ventricular ejection fraction, PCI = percutaneous coronary intervention, V/CrCl = CM volume to creatinine clearance.
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Figure 5: Multivariate Cox regression analysis indicates that a V/CrCl ratio >2.74 is significantly associated with an increased risk of death within 3 years follow-up after PCI. CI = confidence interval, CM = contrast media, DM = diabetes mellitus, HR = hazard ratio, IABP = intra-aortic balloon pump, LVEF = left ventricular ejection fraction, PCI = percutaneous coronary intervention, V/CrCl = CM volume to creatinine clearance.

Mentions: The median follow-up period was 2.51 ± 0.86 years (interquartile range 1.80–3.27 years), and data were available for all who survived to discharge. According to the log-rank analysis, the patients with a V/CrCl ratio >2.74 presented with a higher rate of all-cause mortality than the patients with a V/CrCl ratio ≤2.74 (P = 0.002). The patients with a V/CrCl ratio >2.74 also experienced a relative higher rate of MACEs than the patients with a V/CrCl ratio ≤2.74, although this was not a statistically significant difference (P = 0.065) (Figure 3). In addition, the patients developing CIN presented with a higher rate of all-cause mortality or MACEs than those without CIN during follow-up (both P < 0.001) (Figure 4). Furthermore, Cox regression analysis indicated that the V/CrCl ratio >2.74 remained a significant risk factor for death after PCI, even after adjusting for the baseline clinical variables (hazard ratio = 1.96, 95% CI 1.14–3.38, P = 0.016) (Figure 5).


Safe contrast volumes for preventing contrast-induced nephropathy in elderly patients with relatively normal renal function during percutaneous coronary intervention.

Liu Y, Liu YH, Chen JY, Tan N, Zhou YL, Duan CY, Yu DQ, Xie NJ, Li HL, Chen PY - Medicine (Baltimore) (2015)

Multivariate Cox regression analysis indicates that a V/CrCl ratio >2.74 is significantly associated with an increased risk of death within 3 years follow-up after PCI. CI = confidence interval, CM = contrast media, DM = diabetes mellitus, HR = hazard ratio, IABP = intra-aortic balloon pump, LVEF = left ventricular ejection fraction, PCI = percutaneous coronary intervention, V/CrCl = CM volume to creatinine clearance.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553999&req=5

Figure 5: Multivariate Cox regression analysis indicates that a V/CrCl ratio >2.74 is significantly associated with an increased risk of death within 3 years follow-up after PCI. CI = confidence interval, CM = contrast media, DM = diabetes mellitus, HR = hazard ratio, IABP = intra-aortic balloon pump, LVEF = left ventricular ejection fraction, PCI = percutaneous coronary intervention, V/CrCl = CM volume to creatinine clearance.
Mentions: The median follow-up period was 2.51 ± 0.86 years (interquartile range 1.80–3.27 years), and data were available for all who survived to discharge. According to the log-rank analysis, the patients with a V/CrCl ratio >2.74 presented with a higher rate of all-cause mortality than the patients with a V/CrCl ratio ≤2.74 (P = 0.002). The patients with a V/CrCl ratio >2.74 also experienced a relative higher rate of MACEs than the patients with a V/CrCl ratio ≤2.74, although this was not a statistically significant difference (P = 0.065) (Figure 3). In addition, the patients developing CIN presented with a higher rate of all-cause mortality or MACEs than those without CIN during follow-up (both P < 0.001) (Figure 4). Furthermore, Cox regression analysis indicated that the V/CrCl ratio >2.74 remained a significant risk factor for death after PCI, even after adjusting for the baseline clinical variables (hazard ratio = 1.96, 95% CI 1.14–3.38, P = 0.016) (Figure 5).

Bottom Line: Thirty-nine patients (3.8%) developed CIN.There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001).After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45-7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14-3.38, P = 0.016).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Cardiology (YL, J-yC, NT, Y-lZ, D-qY, N-jX, H-lL), Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences; Department of cardiology, Guangdong General Hospital, Southern Medical University (Y-hL); and Department of Biostatistics (C-yD, P-yC), School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China.

ABSTRACT
The aim of this study was to evaluate contrast media volume to creatinine clearance (V/CrCl) ratio for predicting contrast-induced nephropathy (CIN) and to determine a safe V/CrCl cut off value to avoid CIN in elderly patients with relatively normal renal function during percutaneous coronary intervention (PCI). We prospectively enrolled 1020 consecutive elderly patients (age ≥65 years) with relative normal renal function (baseline serum creatinine <1.5 mg/dL) undergoing PCI. Receiver operating characteristic (ROC) curves were used to identify the optimal cut off value of V/CrCl for detecting CIN. The predictive value of V/CrCl for CIN was assessed with a multivariate logistic regression. Thirty-nine patients (3.8%) developed CIN. There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001). ROC curve analysis indicated that a V/CrCl ratio of 2.74 was a fair discriminator for CIN (C statistic = 0.68). After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45-7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14-3.38, P = 0.016). A V/CrCl ratio >2.74 was a significant independent predictor of CIN and was independently associated with long-term mortality in elderly patients with relatively normal renal function.

Show MeSH
Related in: MedlinePlus