Chulalongkorn Medical Journal


Background : The use of contrast media has been closely related to contrast-inducednephropathy (CIN) in several studies. However, there is no firm descriptionof the association. The volume of contrast media and patient characteristicsmay be important risk factors for CIN. Identifying and quantifying theserisk factors may be useful in predicting risk of CIN.Objective : To identify important risk factors of CIN after percutaneous coronaryintervention (PCI).Design : Prospective analytical studySetting : King Chulalongkorn Memorial HospitalMethod : A total of 181 consecutive patients who underwent PCI were enrolled.Patient- and procedure-related factors including calculated volume/bodyweight (V/BW) ratio were recorded. CIN was defined as an increase inserum creatinine > 25% or > 0.5 mg/dl from pre-PCI value within 72 hoursafter PCI or diagnosed with CIN. Receiver-operator characteristics (ROC)methods were used to determine the optimal cutoff point of V/BW ratio.The V/BW ratio and other factors were tested for an association with CINby multivariate logistic regression analysis.Results : The incidence of CIN after PCI was 6.1%. The mean of V/BW ratio inpatients developing CIN was 3.2 ± 2.0 ml/kg, and those who did notdevelop CIN was 2.0 ± 1.0 ml/kg (p-value = 0.001). The ROC curve analysisindicated that V/BW ratio of 2.6 ml/kg was a good discriminator for CINwith concordance statistic (C-statistic) of 0.73. Multivariate logistic regressionanalysis showed that V/BW ratio ≥ 2.6 ml/kg (OR = 8.184; p-value = 0.003),congestive heart failure (CHF) (OR = 6.465, p-value = 0.010) and creatinineclearance (CrCl) < 30 ml/min (OR = 6.141, p-value = 0.019) were associatedwith CIN after PCI.Conclusions : The risk of CIN after PCI was associated with V/BW ratio ≥ 2.6 ml/kg,CrCl < 30 ml/min and CHF. The V/BW ratio ≥ 2.6 ml/kg may be a usefulpredictor in estimating optimal volume of contrast media for individualpatient.


Faculty of Medicine, Chulalongkorn University

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