Akira Sato1, Kazutaka Aonuma2, Makoto Watanabe3, Atsushi Hirayama4, Nagara Tamaki5, Hiroyuki Tsutsui6, Murohara Toyoaki7, Hisao Ogawa8, Takashi Akasaka9, Michihiro Yoshimura10, Tadateru Takayama4, Mamoru Sakakibara6, Susumu Suzuki7, Kenichi Ishigami11, Kenji Onoue3, Yoshihiko Saito3. 1. Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan. Electronic address: asato@md.tsukuba.ac.jp. 2. Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan. 3. First Department of Internal Medicine, Nara Medical University, Japan. 4. Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan. 5. Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Japan. 6. Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Japan. 7. Department of Cardiology, Nagoya University Graduate School of Medicine, Japan. 8. Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University, Japan. 9. Department of Cardiovascular Medicine, Wakayama Medical University, Japan. 10. Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Japan. 11. Department of Cardiology, Saiseikai-Suita Hospital, Japan.
Abstract
BACKGROUND: The association between the incidence of contrast-induced nephropathy (CIN) and subsequent clinical outcomes is unclear in Japan. We evaluated the association between CIN and cardiovascular and renal events after cardiac catheterization. METHODS: The CINC-J multicenter prospective cohort study examined 853 patients undergoing cardiac catheterization from 27 hospitals. CIN was defined as increase in serum creatinine (SCr)≥0.5mg/dL or ≥25% from baseline between 48 and 72h after exposure to contrast. Major adverse cardiovascular and cerebrovascular events (MACCE) included all-cause deaths, non-fatal myocardial infarction, acute decompensated heart failure (ADHF), and stroke. Renal events included newly-required hemodialysis and increase of SCr≥2× from baseline. RESULTS: During follow-up periods (477±214days), CIN, MACCE, and renal events occurred in 44 (5.2%), 71 (8.3%), and 26 (3.0%) patients, respectively. Kaplan-Meier analysis showed that CIN yielded increasing risk for MACCE, ADHF, newly-required hemodialysis, and renal events. In multivariable Cox proportional hazards analysis, age (HR: 1.03; 95% CI, 1.00-1.07; P=0.0425), anemia (HR: 1.94; 95% CI, 1.08-3.61; P=0.0264), and diabetes mellitus (HR: 1.86; 95% CI, 1.10-3.21; P=0.0119) were independent predictors of MACCE, whereas CIN (HR: 7.78; 95% CI, 3.23-17.9; P=0.0005) and SCr (HR: 2.09; 95% CI, 1.56-2.73; P=0.0006) were independent predictors of renal events. Compared to subjects without both anemia and CIN as the reference, those with both were high risk for MACCE (HR: 3.97; 95% CI, 1.25-10.6; P=0.0218). CONCLUSION: CIN was a significant predictor of subsequent renal events after cardiac catheterization. CIN and anemia were associated with increased risk for worse long-term clinical outcome, especially when both were present.
BACKGROUND: The association between the incidence of contrast-induced nephropathy (CIN) and subsequent clinical outcomes is unclear in Japan. We evaluated the association between CIN and cardiovascular and renal events after cardiac catheterization. METHODS: The CINC-J multicenter prospective cohort study examined 853 patients undergoing cardiac catheterization from 27 hospitals. CIN was defined as increase in serum creatinine (SCr)≥0.5mg/dL or ≥25% from baseline between 48 and 72h after exposure to contrast. Major adverse cardiovascular and cerebrovascular events (MACCE) included all-cause deaths, non-fatal myocardial infarction, acute decompensated heart failure (ADHF), and stroke. Renal events included newly-required hemodialysis and increase of SCr≥2× from baseline. RESULTS: During follow-up periods (477±214days), CIN, MACCE, and renal events occurred in 44 (5.2%), 71 (8.3%), and 26 (3.0%) patients, respectively. Kaplan-Meier analysis showed that CIN yielded increasing risk for MACCE, ADHF, newly-required hemodialysis, and renal events. In multivariable Cox proportional hazards analysis, age (HR: 1.03; 95% CI, 1.00-1.07; P=0.0425), anemia (HR: 1.94; 95% CI, 1.08-3.61; P=0.0264), and diabetes mellitus (HR: 1.86; 95% CI, 1.10-3.21; P=0.0119) were independent predictors of MACCE, whereas CIN (HR: 7.78; 95% CI, 3.23-17.9; P=0.0005) and SCr (HR: 2.09; 95% CI, 1.56-2.73; P=0.0006) were independent predictors of renal events. Compared to subjects without both anemia and CIN as the reference, those with both were high risk for MACCE (HR: 3.97; 95% CI, 1.25-10.6; P=0.0218). CONCLUSION:CIN was a significant predictor of subsequent renal events after cardiac catheterization. CIN and anemia were associated with increased risk for worse long-term clinical outcome, especially when both were present.
Authors: Ovidio De Filippo; Fabrizio D'Ascenzo; Francesco Piroli; Carlo Budano; Gaetano Maria De Ferrari Journal: J Thorac Dis Date: 2019-07 Impact factor: 2.895