Patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are at high risk of contrast-induced acute kidney injury (CI-AKI), a complication that negatively affects outcomes. In primary PCI we have limited time to assess the risk and preventing of CI-AKI. We performed a single-centre prospective study to determine the effect of implementation of algorithm preventing on the incidence of CI-AKI in patients with STEMI and primary PCI.Design and method:
We used of historical control data for assessing of algorithm preventing CI-AKI in routine clinical practice. The study compared two groups of patients with ST-segment elevation myocardial infarction (STEMI) and primary PCI before and after implementation of algorithm preventing CI-AKI. In 1 Group - control group (n = 33) we used the routine prophylaxis CI-AKI: in patients with eGFR <60 ml/min/1,73m2 received intravenous hydration of 0.9% saline solution of sodium chloride (NaCl) at a rate of 1.0–1.5 ml/kg/h before the PCI. In 2 group - prevent group (n = 33) we prevented CI-AKI according to the algorithm: patients with eGFR <60 ml/min/1,73m2 and/or with Mehran risk score >10 received intravenous fluid administration hydration of 0.9% NaCl and N-Acetylcysteine (NAC): 0.9% NaCl x 500–1000 ml before PCI and 1 ml/kg/h post contrast administration with NAC 300 mg before PCI and 900 mg after PCI. Both groups were comparable in age (63 ± 11 and 62 ± 12 years), comorbidity (hypertension 89 and 85%, chronic kidney disease 14 and 15%, diabetes mellitus 19 and 17%) and received therapy. CI-AKI was defined using 2012 KDIGO Guidelines. Isoosmolar contrast media iodixanol (Visipaque-320) or low-osmolar contrast media iohexol (Omnipaque-350) were used. Transradial access for PCI was used in 98% of patients. Mann-Whitney test and multivariate logistic regression analysis were performed. P < 0.05 was considered statistically significant.Results:
The incidence of CI-AKI in intervention group was significantly lower than in the control group (20 and 11%, p < 0.05).Conclusions:
Implementation of algorithm preventing of contrast-induced acute kidney injury significantly reduced the risk of CI-AKI in clinical practice in patient with STEMI and primary PCI.