Original title: Female gender and contrast-induced nephropathy in primary percutaneous intervention for ST-segment elevatio myocardial infarction. Reference: Stefano Lucreziotti, et al. International Journal of Cardiology 2014;174:37-42
Primary PCI has been demonstrated beneficial. However, it is associated to greater contrast-induced nephropathy (CIN) with increased in hospital and long term morbidity and mortality. In addition, several reports have shown women evolve worse after this complication, compared to men. This study analyzed post primary PCI serum creatinine increase in 323 patients.
Baseline was defined as 1.2 mg/dl and CIN was defined as an increase in serum creatinine (≥25% or ≥0.5mg/dl) from baseline during the first 72 hrs. 63% of the general population had a Mehran risk score (MRS) ≥6. Compared to men, women were of older age, had a higher MRS, lower renal function and longer symptom to reperfusion time. CIN predictors included female gender, older age, reduced LV ejection function, preexisting kidney failure and high MRS. The multivariable analysis associated female gender and reduced LV ejection fraction to CIN.
In-hospital mortality was higher in patients developing CIN (20.4% vs. 2.6%; p<0.001), in women (9.3% vs. 3.5%; p=0.02) and in patients with reduced ventricular function (36.7% vs. 2%; p=0.001). The study also divided the population in two groups according to MRS 6, and showed higher mortality in patients with >6 (1.9% vs. 11.3% p<0.001).
Conclusion
In primary PCI, female gender and reduced LVEF are associated to contrast induced nephropathy. This complication is an independent predictor of in-hospital and long term mortality.
Editorial Comment
This analysis shows that, in patients undergoing primary PCI, female gender is an independent predictor of CIN, associated to poor clinical outcomes. This may be due to the fact that females were of older age, had a higher MRS, lower renal function and longer symptom to reperfusion time.
Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation
Buenos Aires
Dr. Carlos Fava para SOLACI.ORG