Clinical outcomes of contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: A prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine
Clinical outcomes of contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: A prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine
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DOI：
10.1016/j.ijcard.2007.05.004
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发表时间：
2008-06-06
影响因子：
3.5
通讯作者：
Kwan, Tak W.
中科院分区：
文献类型：
--
作者：
Chen, Shao Liang;Zhang, Junjie;Kwan, Tak W.
背景资料：水化在预防造影剂肾病（CIN）的潜在作用仍然是不清楚的。方法：936例经皮冠状动脉介入治疗（PCI）患者被纳入本研究，并根据其基线血清肌酐浓度分为正常（血清肌酐= 1.5 mg/dl）组。每组进一步随机分为两个亚组：水化和非水化。异常组患者于造影前12 h及造影后即刻口服乙酰半胱氨酸负荷剂量1200 mg。在入院时（导管插入前），在接下来的三天每天重新测量肌酐浓度。6个月随访期间的主要终点包括临床驱动的血运重建（PCI或CABG），全因死亡，需要紧急肾脏替代治疗。结果：异常组CIN发生率高于正常组（6.52% vs. 37.68%，p= 70岁（比值比[OR] 5.27，95%置信区间[CI] 1.94 - 13.07，p=0.0007），造影剂体积>= 320 ml（OR 3.26，95% CL 2.14至7.58，p=0.01），糖尿病（OR 9.86，95% CL 5.38至31.67，p
Backgrounds: The potential role of hydration in prevention of contrast-induced nephropathy (CIN) still remains to be unclear.Methods: Nine-hundred and thirty-six patients scheduled for percutaneous coronary intervention (PCI) were enrolled into the present study, and divided into normal (serum creatinine= 1.5 mg/dl) groups according to their baseline serum concentration of creatinine. Each group was further randomly divided into two subgroups: hydration and nonhydration. All patients in abnormal group took twice orally loading dose of 1200 mg acetylcysteine (ATLS) at 12 h before scheduled time for coronary angiogram and immediately after procedure. Creatinine concentration was remeasured at the time of admission (just before catheterization), every day for the following three days. The primary end point during 6-month follow-up included clinical driven revascularization (either PCI or CABG), death from all causes, and requiring emergency renal-replacement therapy.Results: The incidence of CIN was more commonly in abnormal group that in normal group (6.52% vs. 37.68%, p= 70 years (odds ration [OR] 5.27, 95% confidence interval [CI] 1.94 to 13.07, p=0.0007), contrast volume >= 320 ml (OR 3.26, 95% CL 2.14 to 7.58, p=0.01), diabetes mellitus (OR 9.86, 95% CL 5.38 to 31.67, p