Key result
Periprocedural intravenous hydration with isotonic saline reduced the incidence of contrast-induced nephropathy compared with no hydration in patients with STEMI undergoing primary PCI.
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?
Meta-Analysis (n=924)
Does periprocedural intravenous hydration with isotonic saline reduce the risk of contrast-induced nephropathy in patients with STEMI undergoing primary PCI?
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.
Answers are grounded in this paper and cite their sources.
Supports routine periprocedural hydration in STEMI primary PCI; confirms CIN reduction from Level 1 meta-analysis of RCTs.
Patients with ST-segment elevation myocardial infarction (STEMI) who are treated by primary percutaneous coronary intervention (PPCI) have an increased risk of developing contrast-induced nephropathy (CIN) when compared with patients undergoing elective percutaneous coronary intervention (PCI). However, CIN prevention measures are less frequently applied in PPCI than in elective PCI. At present, no preventive strategy has been recommended by the current guidelines for patients with STEMI undergoing PPCI.Published research was scanned by formal searches of electronic databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials) from 1966 to July 2018. Internet-based sources of information on the results of clinical trials in cardiology were also searched.A total of three randomized trials involving 924 patients were included in the present meta-analysis, of whom 462 received hydration with isotonic saline (hydration group) and 462 received no hydration (control group). Periprocedural hydration with isotonic saline was associated with a significant decrease in the rate of CIN (16.9% in the hydration group versus 26.4% in the control group; summary risk ratio: 0.64, 95% confidence interval: 0.50-0.82, P = 0.0005). There was no difference in the rate of postprocedural hemodialysis or death between the groups.Intravenous saline hydration during PPCI reduced the risk of CIN without significantly altering the rate of requirement for renal replacement therapy or mortality.
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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 reduced the incidence of contrast-induced nephropathy compared with no hydration in patients with STEMI undergoing primary PCI.
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