Impact of catalytic iron on mortality in patients with acute coronary syndrome exposed to iodinated radiocontrast-The Iscom Study
Impact of catalytic iron on mortality in patients with acute coronary syndrome exposed to iodinated radiocontrast-The Iscom Study
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DOI：
10.1016/j.ahj.2013.02.016
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发表时间：
2013-05-01
影响因子：
4.8
通讯作者：
Rajapurkar, Mohan M.
中科院分区：
文献类型：
--
作者：
Lele, Suhas S.;Mukhopadhyay, Banibrata N.;Rajapurkar, Mohan M.
背景催化铁（CI）通过产生活性氧介导血管损伤。我们评估了CI在预测急性冠脉综合征（ACS）患者死亡率中的作用，并研究了造影剂肾病与CI水平的关系。方法对806例接受心脏手术造影剂暴露的ACS患者进行了30天的随访。结果30 d总死亡率为1.6%。催化铁在基线时预测死亡率，死亡患者CI水平显著高于幸存者，为0.45 mu mol/L(0.37, 0.68)，幸存者为0.31 mu mol/L (0.21, 0.40)；P = 0.004。在调整年龄、糖尿病、ST段偏离、Killip分级、射血分数、基线肌酐、血红蛋白水平和肌钙蛋白后，催化铁与最高四分位数的死亡风险增加相关（风险比7.88,P = 0.001）。55例（6.8%）发生造影剂肾病。对比剂肾病患者从基线到48小时的中位CI水平增加27%，而非对比剂肾病患者的中位CI水平边际增加2.9% （0.37,0.14 mu mol/L至0.47,0.20 mu mol/L与0.35,0.12 mu mol/L至0.36,0.14 mu mol/L, P < 0.0001）。造影剂肾病患者的死亡率明显高于非造影剂肾病患者（9.1% vs 1.1%, P = .001）。结论高基线CI水平可预测ACS患者的死亡率。造影剂肾病的发生与CI水平升高和更高的死亡率相关。缓冲或螯合CI的治疗选择可能对这种情况下的死亡率有有益的影响。（美国心脏杂志2013；165:744-51）
Background Catalytic iron (CI) mediates vascular injury by generating reactive oxygen species. We evaluated role of CI in predicting mortality in patients with acute coronary syndrome (ACS) and studied association of contrast nephropathy with CI levels.Methods We investigated 806 patients with ACS undergoing contrast exposure for a cardiac procedure who were followed up for 30 days.Results Overall mortality was 1.6% at 30 days. Catalytic iron at baseline predicted mortality with CI levels significantly higher in those who died, 0.45 mu mol/L (0.37, 0.68) compared with survivors 0.31 mu mol/L (0.21, 0.40); P = .004. Catalytic iron was associated with increased risk of death in the highest quartile compared with lower 3 quartiles (hazard ratio 7.88, P = .001) after adjustment for age, diabetes, ST deviation, Killip class, ejection fraction, baseline creatinine, hemoglobin level, and troponin. Fifty-five patients (6.8%) developed contrast nephropathy. Patients with contrast nephropathy had a 27% increase in median CI levels from baseline up to 48 hours compared with a marginal 2.9% increase in those without contrast nephropathy (0.37, 0.14 mu mol/L to 0.47, 0.20 mu mol/L versus 0.35, 0.12 mu mol/L to 0.36, 0.14 mu mol/L, P < .0001). Patients with contrast nephropathy had significantly higher mortality compared with those without contrast nephropathy (9.1% vs 1.1%, P = .001).Conclusion High baseline CI levels predicted mortality in patients with ACS. Occurrence of contrast nephropathy was associated with rise in CI levels and higher mortality. Therapeutic options to buffer or chelate CI may have beneficial effects on mortality in this setting. (Am Heart J 2013;165:744-51.)