Open AccessAssociation Between Acidosis Soon After Reperfusion and Contrast‐Induced Nephropathy in Patients With a First‐Time ST ‐Segment Elevation Myocardial Infarction
Author(s) -
Gohbara Masaomi,
Hayakawa Azusa,
Akazawa Yusuke,
Furihata Shuta,
Kondo Ai,
Fukushima Yusuke,
Tomari Sakie,
Endo Tsutomu,
Kimura Kazuo,
Tamura Kouichi
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.006380
Subject(s) - medicine , contrast induced nephropathy , cardiology , myocardial infarction , acidosis , odds ratio , creatinine , metabolic acidosis , renal function , incidence (geometry) , nephropathy , acute kidney injury , diabetes mellitus , percutaneous coronary intervention , endocrinology , physics , optics
Background Contrast‐induced nephropathy ( CIN ) is associated with poor outcomes in patients with acute myocardial infarction. However, the predictors of CIN have yet to be fully elucidated. Methods and Results The study included 273 consecutive patients with a first‐time ST ‐segment elevation myocardial infarction who underwent reperfusion within 12 hours of symptom onset. The exclusion criteria were hemodialysis, mechanical ventilation, or previous coronary artery bypass grafting. All patients underwent arterial blood gas analysis soon after reperfusion. CIN was defined as an increase of 0.5 mg/dL in serum creatinine or a 25% increase from baseline between 48 and 72 hours after contrast medium exposure. Acidosis was defined as an arterial blood pH <7.35. CIN was observed in 35 patients (12.8%). Multivariable logistic regression analysis with forward stepwise algorithm revealed a significant association between CIN and the following: reperfusion time, the prevalence of hypertension, peak creatine kinase‐ MB , high‐sensitivity C‐reactive protein on admission, and the incidence of acidosis ( P <0.05). Multivariable logistic regression analysis revealed that the incidence of acidosis was associated with CIN when adjusted for age, male sex, body mass index, amount of contrast medium used, estimated glomerular filtration rate on admission, glucose level on admission, high‐sensitivity C‐reactive protein on admission, and left ventricular ejection fraction ( P <0.05). Moreover, the incidence of acidosis was associated with CIN when adjusted for the Mehran CIN risk score (odds ratio: 2.229, P =0.049). Conclusions The incidence of acidosis soon after reperfusion was associated with CIN in patients with a first‐time ST ‐segment elevation myocardial infarction.