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Volume‐to‐creatinine clearance ratio in patients undergoing coronary angiography with or without percutaneous coronary intervention: Implications of varying definitions of contrast‐induced nephropathy
Author(s) -
Capodanno Davide,
Ministeri Margherita,
Cumbo Silvia,
Dalessandro Veronica,
Tamburino Corrado
Publication year - 2013
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.25153
Subject(s) - creatinine , medicine , percutaneous coronary intervention , contrast induced nephropathy , renal function , urology , conventional pci , coronary angiography , nephropathy , cardiology , confidence interval , endocrinology , myocardial infarction , diabetes mellitus
Objectives Whether predicting the risk of early serum creatinine rise using the ratio of the volume of contrast media administered to the estimated creatinine clearance (V/CrCl) is applicable to the broader definition of contrast‐induced nephropathy (CIN) (≥0.5 mg/dL absolute and/or 25% relative increase from baseline serum creatinine) is unknown. Background A V/CrCl ≥4 has been proven to predict the risk of ≥0.5 mg/dL postprocedural absolute rise in serum creatinine. Methods A total of 722 patients undergoing coronary angiography ± percutaneous coronary intervention (PCI) between March 2011 and October 2011 with paired serum creatinine determinations at preprocedure and within 72‐hr postprocedure were analyzed. The V/CrCl ratio was calculated by dividing the volume of contrast received by the patient's creatinine clearance. CIN using different definitions was termed as CIN narrow (rise in serum creatinine ≥0.5 mg/dL) and CIN broad (rise in serum creatinine ≥0.5 mg/dL and/or ≥25% increase in baseline serum creatinine). Results The mean age was 66 ± 11 years and the mean baseline serum creatinine was 1.1 ± 0.8 mg/dL. Patients with V/CrCl ≥4 were significantly older and more frequently underwent ad hoc PCI compared with those with V/CrCl <4. CIN narrow and CIN broad were observed in 13 versus 3% ( P < 0.001) and 23 versus 11% ( P < 0.001) of patients with or without V/CrCl ≥4, respectively. After statistical adjustment, a V/CrCl ratio ≥4 remained significantly associated with the risk of both CIN narrow [adjusted OR 3.5, 95% confidence intervals (95% CI) 1.7–7.3; P < 0.001] and CIN broad (adjusted OR 2.5, 95% 1.6–3.9; P < 0.001). Conclusions A volume‐to‐creatinine clearance ratio ≥4 significantly predicts the risk of early postprocedural rise in serum creatinine regardless of the CIN definition adopted. © 2013 Wiley Periodicals, Inc.