Incidence, Risk factors, and Clinical Outcomes of Contrast Induced Nephropathy After Percutaneous Coronary Intervention in Elderly Patients

BACKGROUND: Contrast induced nephropathy(CIN) has been known to be a risk factor of significant in-hospital and long-term adverse outcomes. In old aged patients undergoing percutaneous coronary intervention(PCI) in the modern era, the incidence and prognostic implications of nephropathy are unknown. METHODS: With a retrospective analysis of the clinical and angiographic data, we determined the incidence of, risk factors for, and prognostic implications of CIN(defined as an increase in serum creatinine[Cr] >0.5 mg/dL from baseline) after PCI. RESULTS: Of 360 patients, 16(4.4%) patients experienced CIN and 5(1.4%) patients required temporary renal replacement therapy (hemodialysis or hemofiltration). Patients with baseline Cr 1.4 mg/dL and diabetic patients had a significant risk of CIN. In multivariate analysis, CIN was significantly associated with baseline renal dysfunction and diabetes showed marginal significance in developing CIN. Twenty-five percent of patients with CINdied during the index hospitalization compared with only 1.2% of patients without CIN (p<0.001). In patients with CIN, events of CIN impair renal function at six-month follow up. CONCLUSIONS: In old aged patients who are undergoing PCI, diabetic patients with baseline renal impairment are at higher risk for CIN. Furthermore, CIN was highly correlated with death during the index hospitalization.

Relationship between Initial Leukocyte Count and the Extent of Myocardial Injury in Patients with Acute Myocardial Infarction Who Received Reperfusion Therapy

BACKGROUND AND OBJECTIVES: The presence of leukocytosis in patients with acute myocardial infarction (AMI) has been reported to be related to the extent of MI and with the prognosis. However, whether the leukocytosis itself is a cause or result of the myocardial injury has not been determined. The relationship between the leukocyte count and the extent of myocardial injury was investigated in patients with AMI that had undergone reperfusion therapy. SUBJECTS AND METHODS: Patients with AMI that had undergone thrombolysis (n=60) or primary PCI (n=36) were included. The initial leukocyte counts were analyzed with regard to the peak and initial CK-MB levels. The relationship between leukocytosis and the time elapsed from the onset of symptoms, infarct related coronary arteries and the proximity of the lesions were also investigated. RESULTS: In both groups, the initial leukocyte count did not show a significant relationship with the initial CK-MB level or the time elapsed from symptoms onset, which could be an indication of the extent of early myocardial injury. Furthermore, no significant relationship was shown with the infarct related coronary artery or proximity of the lesion. However, a relationship was shown with the maximum CK-MB level, which could be an indication of the extent of myocardial injury following reperfusion therapy in both groups (p<0.01). CONCLUSION: This study suggests that the initial leukocyte count in patients with AMI might is an important prognostic factor that determines the extent of myocardial injury following reperfusion therapy, rather than being a simple indicator of the extent of early myocardial injury.