Abstract:Aim To evaluate the association between left ventricular end-diastolic pressure (LVEDP) and contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI). Methods Single center clinical data of patients who underwent PCI were retrospectively analysed to explore the predictive value of LVEDP for the occurrence of CIN. Results Among 1 301 patients who underwent PCI during the study period, 125 patients (9.61%) developed CIN. Risk factors for CIN included age, female, chronic kidney disease, history of diabetes mellitus, anemia, heart failure and emergencies in our study cohort. Compared with non-CIN group, the average LVEDP was higher in patients with CIN after PCI ((18.4±8.7) mmHg vs (14.4±6.6) mmHg, P<0.001). Multiple regression analysis showed that LVEDP (≥20 mmHg) could independently predict the occurrence of CIN (OR 1.6,5%CI 1.08～1.47). The predictive value of LVEDP for CIN was enhanced in patients with low ejection fraction. Contrast dosage in high-risk patients determined by elevated LVEDP was comparable to that in patients not found. Conclusions LVEDP is an independent predictor for CIN. Patients with elevated LVEDP (≥20 mmHg) are at higher risk of CIN after PCI. In CIN prevention, high-risk patients defined by elevated LVEDP need to be noticed by clinicians.

Abstract:Aim To find risk factors of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in elderly diabetic patients with acute coronary syndrome (ACS). Methods 134 cases of elderly diabetic patients with ACS (≥65 years old) was involved in this study. In the same period, 145 cases of PCI patients without diabetes were used as controls. The age, preoperation brain natriuretic peptide (BNP), ejection fraction, 25 hydroxyvitamin D, estimated glomerular filtration rate (eGFR), blood albumin and so on were compared between the two groups. Multifactor logistic regression analysis was used to find risk factors of CIN. Results 17 cases of CIN were found in 134 cases of patients with diabetes after PCI, the incidence was 12.6%. In 145 elderly patients without diabetes, there were 13 cases of CIN, with an incidence of 8.9%, there was no statistically significant difference between the two groups (P＞0.05). Statistically difference was found in gender and perioperative use of ACEI/ARB between two groups (P<0.05). Preoperation BNP, fibrinogen, platelet volume distribution of the diabetes group was higher than non-diabetic, 25 hydroxyvitamin D was lower than non-diabetic group (P<0.05). Loistic regression analysis showed that fibrinogen and 25 hydroxyvitamin D were the risk factors of CIN for elderly diabetic patients with acute coronary syndrome after PCI. Preoperative fibrinogen elevation increased the risk of CIN (OR=3.3,5%CI 1.353～6.845, P=0.007), 25 hydroxyvitamin D reduction increased the risk of CIN (OR=0.5,5%CI 0.282～0.833, P=0.009). Conclusion The risk of CIN was increased when preoperative fibrin was elevated and 25 hydroxyvitamin D was decreased in elderly diabetes mellitus patients with acute coronary syndrome after PCI.

Abstract:Aim To investigate the relationship between serum uric acid on admission and incidence of contrast-induced nephropathy (CIN) in patients with coronary heart disease complicated with diabetes mellitus. Methods A total of 150 patients with coronary heart disease complicated with diabetes mellitus were divided into two groups:control group (n=95) and increased serum uric acid group (n=55). The incidence of CIN was compared between the two groups and the risk factors of CIN were analyzed by Logistic regression. Results The incidence of CIN in 55 patients with increased serum uric acid was 27.27% (15/55),and it was significantly higher than that in patients with normal serum uric acid [10.53%(10/95), P=0.008]. Multivariate Logistic regression analysis revealed that the independent risk factors of CIN were serum uric acid (OR 1.7,5% confidence interval:1.001～1.013, P=0.014) and contrast dosage (OR 1.5,5% confidence interval:1.017～1.054, P=0.000). Conclusion Increased serum uric acid on admission is independently associated with higher risk of CIN among patients with coronary heart disease complicated with diabetes mellitus.

Abstract:Aim To investigate the relationship between nonalcoholic fatty liver disease (NAFLD) and contrast-induced nephropathy (CIN) in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods A total of 261 consecutive patients with acute myocardial infarction undergoing PCI in our hospital from March 2014 to May 2016 were enrolled in this study. Patients were divided into NAFLD group (n＝117) and non-NAFLD group (n＝144) based on the diagnosis of B-mode ultrasound. CIN was defined as≥44.2 μmol/L or ≥25％ increase from baseline serum creatinine within 48～72 hours after contrast medium exposure, and that was not attributable to other causes. The following data were recorded:the baseline measurements, blood urea nitrogen, serum creatinine levels before PCI and 1,2 and 3 days after PCI, estimated glomerular filtration rate (eGFR), the contrast volume and coronary pathological features after PCI. Risk factors for CIN were determined by multivariate Logistic regression analysis. Results CIN occurred in 16.5% (43/261) of patients, and incidence of CIN was significantly higher in the NAFLD group than that in the non-NAFLD group [23.93%(28/117) vs. 10.42% (15/144), P＝0.003]. Compared with adverse events in the hospital, the incidence of acute heart failure in NAFLD group was higher (P＜0.05). Multivariate Logistic regressive analysis showed that NAFLD (OR＝2.18), diabetes (OR＝2.42), contrast volume (OR＝2.44) were risk factors for the incidence of CIN. Conclusion NAFLD is the independent risk predictor of CIN in patients with AMI undergoing PCI.

Abstract:Aim To study the beneficial effects of high dose atorvastatin sequential treatment in preventing contrast-induced nephropathy (CIN) in acute non-ST-segment elevation acute myocardial infarction (NSTEMI) patients underwent elective percutaneous coronary intervention (PCI). Methods One hundred patients with NSTEMI undergone elective PCI were randomly divided into two groups:high dose atorvastatin sequential treatment group (sequential treatment group for short) and control group. All patients were given 80 mg atorvastatin instantly and then 40 mg once a day. On the basis of hydration therapy, sequential treatment group received additional 40 mg atorvastatin at 6 hours before PCI. Serum creatinine (Scr), endogenous creatinine clearance rate (Ccr) and the incidence rate of CIN were measured and compared 24 hours and 48 hours post-PCI. Results The levels of Scr, Ccr had no significant difference in the two groups at all time points. Compared with the preoperative, Scr and Ccr had no significant changes postoperatively in sequential treatment group. In control group, Scr and Ccr had no significant change 24 hours postoperatively, Scr had significantly increased, Ccr had significantly decreased after 48 hours (P＜0.05). Compared with 24 h postoperatively, Scr had significantly increased, Ccr had significantly decreased (P＝0.00). Scr decreased to the normal range after 7~10 days in all patients with CIN. The CIN incidence rate had no significant difference in the two groups (16% vs. 15%, P＝0.585). Conclusion For patient who had used lipid-lowering program before PCI:40 mg/d atorvatatin, the strategy of re-load atorvastatin 40 mg can not reduce the CIN incidence rate.

Abstract:Aim To explore the predictive value of red cell distribution width (RDW) for contrast-induced nephropathy (CIN) in patients of type 2 diabetes with percutaneous coronary intervention (PCI). Methods A total of 310 ACS patients who received PCI treatment in the hospital from January of 2013 to December of 2015 were retrospectively studied in this project. These patients were divided into 2 groups by serum creatinine before and after surgery:Non-CIN group(n=275); CIN group(n=35), compared to the baseline condition at admission, the patients either had the serum level of creatinine raising up 25% or the serum level of creatinine increasing ≥ 0.5 g/L within 72 hours after PCI. Results The study found that under the same risk factors, compared with Non-CIN group, the RDW in the CIN group had increased, all P<0.05. Logistic analysis revealed RDW was the independent risk factor for CIN. Conclusion Elevated RDW has the predictive value for CIN occurrence in type 2 diabetes with PCI treatment.

Abstract:Aim To investigate the effect of obstructive seep apnea hypoventilation syndrome （OSAHS） on the morbidity of contrast-induced nephropathy （CIN） in patients with coronary heart disease （CHD）.Methods 110 patients were divided into CHD without OSAHS group （n＝48） and CHD with OSAHS group （n＝62） according to diaognostic coronary angiography （CAG） and polysomnography （PSG）.Before and after coronary angiography or percutaneous coronary intervention （PCI）,the level of serum creatinine was compared between the two groups.The morbidity of CIN was compared between the two groups.Results The difference of the level of serum creatinine was not statistically significant between the two groups before coronary angiography （t＝－0.733,P＝0.465）.The difference of the level of serum creatinine was statistically significant between the two groups after coronary angiography or percutaneous coronary intervention （t＝－2.486,P＝0.014 t＝－2.921,P＝0.004）.The morbidity of CIN was higher in CHD with OSAHS group （χ2＝4.013,P＝0.045）.Conclusion OSAHS is a risk factor of CIN in patients with CHD.

Abstract:AimTo observe the effects of hydration on renal function and the incidence of contrast-induced nephropathy in patients undergoing coronary angiography.MethodsThe low osmolar and nonionic contrast media (iohexol) was used in all patients.A total of 216 patients, who would undergo coronary angiograph or percutaneous coronary interventional theraphy were enrolled into the study.They were randomly divided into two groups: the hydration group(n=112) and the control group (n=104).The treated group received hydration theraphy as well as general intravenous fluid infusion.The control group only received general intravenous fluid infusion.The levels of serum creatinine (Scr) and urine β2-microglobulin (β2MG) were measured before angiography and 48 hours, one week after coronary angiograpy.The incidence of contrast-induced nephropathy (CIN) was observed in the two groups.ResultsThe levels of Scr and β2MG were both elevated in the two groups, especially in the control group.The levels began to decrease after one week.The incidence of CIN was 4% in hydration group, 17% in control group.ConclusionThe strengthened hydration therapy can reduce the renal damage and effectively prevent from contrast-induced nephropathy.

Abstract:Aim To investigate the risk factors of contrast-induced Nephropathy(CIN) in the percutaneous coronary intervention(PCI). Methods To collect the clinical data of 172 patients who underwent the PCI from January,2008 to December,2009,compare contrast agents dose,recorded the creatinine(Cre) before and after treatment,and analyse the risk factors for occurrence of CIN. Results There were 32 cases occurred CIN,including 21 cases(13%) with GFR >60 mL/min,and 19 cases(40%) with GFR<60 mL/min(P<0.001).The incidence rate was 18.61 %(32/172).The following variables may be the significant factors correlating with CIN: aged≥75 years,three teams of coronary lesions,LVEF<40%,Cre<133 μmol/L and contrast agents dose>300 mL(P<0.001).The incidence of CIN in those patients who had renal dysfunction combining with diabetes mellitus or hypertension was higher than those without renal dysfunction(P<0.01). Conclusion renal damage and the degree of it are the most significant risk factors of CIN development after PCI.Renal insufficiency,aged≥75 years,multivessel coronary artery disease,LVEF<40%,and contrast agents dose>300 mL,are all independent risk factors of CIN.Patients with diabetes or hypertension and pre-existing renal insufficiency have a greater risk of CIN.