麻豆传媒

A scoring system identified patients at high risk for acute kidney injury after multivessel stenting for ST-segment elevation MI (STEMI) with good accuracy, researchers found after determining in a pooled analysis that multivessel procedures were by themselves not a predictor of contrast-induced nephropathy.

In the meta-analysis, acute kidney injury (AKI) was (PCI) than stenting only the infarct-related artery (1.45% versus 1.94%, RR 0.73, 95% CI 0.34-1.57), according to , of St. Luke's-Roosevelt Hospital Center of the Mount Sinai Health System in New York City, and colleagues.

"There does not appear to be an enhanced risk in contemporary clinical practice with multivessel PCI compared with a single-vessel PCI strategy in STEMI based on prior studies," they wrote online in Catheterization and Cardiovascular Interventions. "However, this important safety endpoint should be considered in future randomized trials."

Three out of the four trials included in the meta-analysis (PRAMI, CvLPRIT, and DANAMI3-PRIMULTI) reported higher contrast volumes given to patients during multivessel stenting.

It's the second finding in the past week to suggest that contrast agents aren't as risky as once thought: a large, single-center study published in Annals of Emergency Medicine found from use of CT contrast agents.

When asked about the disconnect between multivessel stenting and contrast-induced kidney injury, Chatterjee explained to 麻豆传媒: "This is an interesting issue -- while empirically we assume that more contrast is needed for multivessel PCI in acute MI, it really does not necessarily have to be the case. Also the better reperfusion achieved with multivessel PCI may improve kidney perfusion as well, thereby being protective for contrast-induced nephropathy."

"[The] risk of contrast-induced nephropathy may not be prohibitive for multivessel PCI," he emphasized.

Chatterjee and colleagues found that the -- derived by study co-author , of Mount Sinai Hospital in New York City -- had an accuracy rate of 78% for identifying the patients who developed contrast-related nephropathy after multivessel stenting (P=0.002). The model had an accuracy of 73% for patients who only had culprit vessel PCI (P<0.001), the authors added.

Included in the Mehran risk score are patient-related variables such as older age, diabetes, hypotension; and procedure-related variables like the use of elective intra-aortic balloon pump and the total volume of contrast administered.

For now, the current study rules out multivessel PCI as one of those variables.

"In my humble opinion, all cardiologists who are concerned about their patients developing contrast-induced nephropathy post-procedure will want to use [the Mehran score] to identify high-risk patients for contrast-induced nephropathy," he said.

He also suggested that interventionists "strongly consider" AKI risk assessment tools like the Mehran score for patients scheduled for multivessel procedures in the cath lab, while "aggressively" hydrating and monitoring those at highest risk.

The authors included four randomized trials (n=1,602) comparing multivessel and culprit lesion stenting in their meta-analysis. Separately, for the Mehran score validation, they accessed the Nationwide Inpatient Sample for the records of 11,454 patients who got multivessel PCI for STEMI from 2009 to 2012.

Patients who got PCI on more than one vessel were healthier to begin with -- being younger, and less likely to present with comorbidities such as congestive heart failure and renal disease -- though propensity score matching cancelled out the baseline difference between groups.

"The Mehran scoring system was adopted specifically for contrast-induced acute kidney injury risk stratification in patients undergoing PCI and has been validated in 8,357 patients, including 'high-risk' patients," the authors wrote. "It has also been validated in groups undergoing both elective and emergency procedures for STEMI and NSTEMI."

The study had limitations, such as its post hoc analyses, which are subject to potential confounding despite the propensity score-matched populations.

Even so, "readily available variables may help in discriminating those at highest risk for contrast-induced acute kidney injury at the time of treatment with PCI," they concluded.

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