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August 22, 2019International Heart JournalOpen Access

Periprocedural intravenous hydration with isotonic saline significantly reduced the incidence of contrast-induced nephropathy (16.9% vs 26.4%; RR 0.64) compared with no hydration in patients with STEMI undergoing primary PCI.

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Why the study?

Patients with STEMI undergoing PPCI have an increased risk of CIN compared to elective PCI, but prevention measures are applied less frequently and current guidelines recommend no preventive strategy.

Does periprocedural intravenous hydration with isotonic saline reduce the risk of contrast-induced nephropathy in patients with STEMI undergoing primary PCI?

Population

924 patients undergoing PPCI across three randomized trials

Comparison

Periprocedural hydration with isotonic saline vs no hydration

Design

Meta-analysis of randomized trials

Key result

Periprocedural intravenous hydration with isotonic saline significantly reduced the incidence of contrast-induced nephropathy (16.9% vs 26.4%; RR 0.64) compared with no hydration in patients with STEMI undergoing primary PCI.

Authors

ZWZhuoqun WangYSYun-Ping SongAGA Geru

Discussion

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Overview

Supports routine periprocedural hydration in STEMI primary PCI; confirms CIN reduction from Level 1 meta-analysis of RCTs.

Study Design

Type

Meta-Analysis (n=924)

Structured PICO

Does periprocedural intravenous hydration with isotonic saline reduce the risk of contrast-induced nephropathy in patients with STEMI undergoing primary PCI?

P
Population
924 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, included in a meta-analysis of three randomized trials.
I
Intervention
Periprocedural intravenous hydration with isotonic saline
C
Comparator
No hydration
O
Outcome
Rate of contrast-induced nephropathy (CIN)safety

Main Result

Relative Risk: 0.64 (95% CI 0.5–0.82)

Absolute Event Rate: 16.9% vs 26.4%

p-value: p=0.0005

Intravenous saline hydration during primary PCI for STEMI significantly reduces the risk of contrast-induced nephropathy without altering mortality or the need for renal replacement therapy.

Limitations

  • Significant crossover rate between the two treatment groups
  • All included trials were single-center studies without blinding
  • Small number of eligible trials, limiting the power to detect publication bias
  • Total number of patients was not large, limiting the ability to detect meaningful differences in secondary outcomes

Cite This Study

Wang et al. (2019) conducted a meta-analysis in ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) (n=924). Hydration with isotonic saline vs. No hydration was evaluated on Incidence of contrast-induced nephropathy (CIN) (RR 0.64, 95% CI 0.50-0.82, p=0.0005). Periprocedural intravenous hydration with isotonic saline significantly reduced the incidence of contrast-induced nephropathy (16.9% vs 26.4%; RR 0.64) compared with no hydration in patients with STEMI undergoing primary PCI.

synapsesocial.com/papers/6a9fcb38fb5e17fb76d559b9https://doi.org/10.1536/ihj.18-725
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The Impact of Hydration and Other Strategies in prevention of Contrast-Induced Nephropathy2024
  2. 2Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction2004 · 758 citations
  3. 3Contrast-induced Nephropathy: Incidence and Reversibility in Patients Undergoing High-risk Percutaneous Coronary Intervention2024
  4. 4Comparison of oral and intravenous hydration strategies for the prevention of contrast-induced nephropathy in patients undergoing coronary angiography or angioplasty:A randomized clinical trial2012 · 3 citations
  5. 5Contrast Induced Nephropathy in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention2022 · 1 citations