Comparison of Risks and Clinical Predictors of Contrast‐Induced Nephropathy in Patients Undergoing Emergency versus Nonemergency Percutaneous Coronary Interventions

BACKGROUND: Contrast nephropathy (CIN) increases adverse clinical outcomes. We examine risks and clinical predictors of CIN in patients undergoing percutaneous coronary intervention (PCI) and effectiveness of prophylactic therapy. METHODS: A cohort of 8,798 patients who underwent PCI from May 2000 to April 2008 was enrolled. We divided patients into 3 groups. A: STEMI patient undergoing primary PCI; B: UA/NSTEMI patients undergoing early PCI; C: Patients without MI undergoing elective PCI. Pre-PCI saline hydration was given to group B and C if baseline glomerular filtration rate (GFR) 70, female gender, anemia, low systolic BP 60 were 8.2%, 9.2%, and 4.3% in group A, B, and C respectively (p < 0.0005). Incidence of CIN in patients with GFR = 30-60 were 19.1%, 4.5%, and 2.4% (p < 0.0005) and in patients with GFR < 30 were 34.4%, 40.0%, and 25.9% (p = 0.510). CONCLUSIONS: Pre-hydration prophylaxis was effective in preventing CIN in mild renal impaired patients (GFR 30-60) but are less so in more severely renal impaired patients (GFR < 30). STEMI patients undergoing primary PCI regardless of baseline GFR were at high risk. Accelerated prophylactic regime can be considered in this cohort.