Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction: Is it Affected by Treatment Strategy?

Background: Contrast-induced nephropathy (CIN) is a frequent complication after percutaneous coronary intervention (PCI) and severely affects morbidity and mortality, especially in patients with ST-segment elevation myocardial infarction.

Objective: This study sought to determine the incidence, risk factors, and in-hospital outcome of CIN in patients with ST-segment elevation myocardial infarction managed by pharmacoinvasive strategy (PIS) versus those managed by primary PCI (PPCI).

Methods: The study was conducted on 670 patients with ST-segment elevation myocardial infarction divided into 2 groups: group I (PPCI group) and group II (PIS group), the 2 groups were compared with each other for the incidence of CIN, risk factors, and in-hospital major adverse cardiac events.

Results: The incidence of CIN in the PIS group (30 patients, 8.8%) was lower than PPCI group (36 patients, 10.9%); however, there was no statistically significant difference between the 2 groups (p = 0.365). Multivariate regression analysis showed that advanced age >60 years (odds ratio [OR] = 4.453; 95% confidence interval [CI]: 2.489 to -7.967; p = 0.001), history of diabetes mellitus (OR = 2.366; 95% CI: 1.298 to -4.315; p = 0.005) and hypertension (OR = 1.930; 95% CI: 1.053 to -3.539; p = 0.034), volume of contrast agent >180 ml (OR = 2.276; 95% CI: 1.290 to -4.016; p = 0.005), and cardiogenic shock (OR = 4.098; 95% CI: 1.726 to -9.728; p = 0.001) were the independent predictors of CIN. Mortality and major adverse cardiac events were significantly higher in patients with CIN.

Conclusions: The incidence of CIN was slightly lower in PIS as compared to PPCI; however, this reduction was not statistically significant. The independent predictors of CIN were advanced age, history of diabetes mellitus and hypertension, high dose of contrast agent, and cardiogenic shock.