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Contrast medium volume to creatinine clearance ratio: A predictor of contrast‐induced nephropathy in the first 72 hours following percutaneous coronary intervention
Author(s) -
Tan Ning,
Liu Yong,
Zhou YingLing,
He PengCheng,
Yang JunQing,
Luo JianFang,
Chen JiYan
Publication year - 2012
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.23048
Subject(s) - medicine , contrast induced nephropathy , percutaneous coronary intervention , odds ratio , renal function , urology , conventional pci , quartile , creatinine , cardiology , receiver operating characteristic , nephropathy , interquartile range , population , area under the curve , confidence interval , myocardial infarction , endocrinology , environmental health , diabetes mellitus
Objectives : To investigate the predictive value of the contrast media volume to creatinine clearance (V/CrCl) ratio for the risk of contrast‐induced nephropathy (CIN) (i.e., within 48–72 hr) and to determine a relatively safe V/CrCl cut‐off value to avoid CIN in patients following percutaneous coronary intervention (PCI). Background : The V/CrCl ratio is a pharmacokinetic risk factor for an early abnormal increase in serum creatinine (i.e., within 24 hr) after PCI. Methods : V/CrCl ratios were obtained from 1,140 consecutive consenting patients after unselective PCI. Receiver‐operator characteristic (ROC) curves were used to identify the optimal sensitivity for the observed range of V/CrCl. The predictive value of V/CrCl for the risk of CIN was assessed using multivariate logistic regression. Results : Fifty‐five (4.8%) patients out of 1,140 developed CIN. There was a significant association between higher V/CrCl ratio values and risk of CIN in the overall population: 1.4%, 1.4%, 5.7%, and 10.9% for quartile 1 (Q1) of the V/CrCl value (<1.56, n = 283), Q2 (1.56–2.27, n = 289), Q3 (2.28–3.42, n = 282), and Q4 (>3.42, n = 285) of contrast, respectively ( P < 0.001). ROC curve analysis indicated that a V/CrCl ratio of 2.62 was a fair discriminator for CIN (C‐statistic 0.73). After adjusting for other known predictors of CIN, V/CrCl ratios > 2.62 remained significantly associated with CIN (odds ratio: 2.20; 95% confidence interval: 1.00–4.81, P < 0.05). Conclusion : A V/CrCl ratio > 2.62 was a significant and independent predictor of CIN after PCI in unselected patients. © 2011 Wiley Periodicals, Inc