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Statins for prevention of contrast‐induced nephropathy in patients undergoing non‐emergent percutaneous coronary intervention
Author(s) -
KANDULA PRAVEEN,
SHAH RAVISH,
SINGH NISHITH,
MARKWELL STEPHEN J,
BHENSDADIA NISHANT,
NAVANEETHAN SANKAR D
Publication year - 2010
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2009.01204.x
Subject(s) - medicine , contrast induced nephropathy , percutaneous coronary intervention , conventional pci , incidence (geometry) , nephropathy , statin , dialysis , acute coronary syndrome , atorvastatin , propensity score matching , creatinine , randomized controlled trial , surgery , gastroenterology , myocardial infarction , endocrinology , physics , optics , diabetes mellitus
Aim: Oxidative stress and ischaemia are suggested as possible mechanisms of contrast‐induced nephropathy (CIN). Statins may offer renoprotection in both acute and chronic kidney diseases because of their antioxidant and anti‐inflammatory properties. We investigated whether use of statins before non‐emergent percutaneous coronary intervention (PCI) reduces the incidence of CIN. Methods: We retrospectively evaluated 540 consecutive adult patients who underwent non‐emergent PCI over a 3 year period at a tertiary care centre. CIN was defined as 25% or 44 mmol/L increase from baseline creatinine at 48–72 h. In addition, we classified patients based on Mehran score for risk of development of CIN and analysed the effect of statins. Results: Three‐hundred and fifty‐three patients met inclusion criteria. Two‐hundred and thirty‐nine patients were taking statins before PCI and 114 were not. Baseline characteristics were similar for both groups. CIN occurred in 75 patients (21.2%). There was a higher incidence of CIN in patients on statins as compared with patients not on statins (24.7% vs 14%; 95% CI: 1.09–3.67; P = 0.02). However, propensity‐based adjustment for receipt of statins revealed no significant differences in CIN between both groups (OR: 1.6; 95% CI: 0.87–3.22; P = 0.12). Multivariate logistic regression revealed Mehran score to be independently predictive of CIN. None of the patients who developed CIN required dialysis. Conclusions: Statin use before non‐emergent PCI is not associated with reduction in CIN. Further randomized controlled trials based on proper risk adjustment for development of CIN are needed.