Gökay TAYLAN, Çağlar KAYA, İlhan KILIÇ, Cihan ÖZTÜRK, Kenan YALTA

Koroner no-reflow fenomeninde kontrast ilişkili akut böbrek hasarını öngördüren faktörler

Giriş: Perkutan koroner girişim (PKG) uygulananlarda, koroner no-reflow fenomeni genellikle TIMI (Miyokard Enfarktüsünde Tromboliz) skorunun değerlendirilmesi ile belirlenir. Kontrast kaynaklı akut böbrek hasarı (CI-AKI) da bu hastalarda sık görülen bir problem olmuştur. Bu çalışmada, koroner no-reflow fenomeni olan hastalarda CI-AKI gelişimi için potansiyel risk faktörlerini değerlendirmeyi amaçladık. Yöntemler: Kardiyoloji kliniğimize 2014-2019 yılları arasında PKG uygulanan ardışık koroner arter hastalığı (KAH) hastalarını dahil ettik. Çok değişkenli lojistik regresyon analizi ile PKG sonrası no-reflow fenomeni gelişen hastalarda CI-AKI ile ilişkili bağımsız değişkenler değerlendirildi. İstatistiksel anlamlılık sınırı olarak bir P değeri <0.05 kabul edildi. Bulgular: 3034 hastadan oluşan popülasyondan 93'üne (% 3) koroner no-reflow (% 64 erkek, ortalama yaş 64 ± 12) tanısı kondu. CI-AKI koroner no-reflow saptanan hastaların % 22'sinde görüldü (n = 20). Çok değişkenli analiz, PKG sonrası TIMI akım 0-1, kontrast miktarı ve pulmoner arteriyel hipertansiyonun (PHT) koroner no-reflow fenomeninde CI-AKI' nin gelişimi ile anlamlı ilişkilerini göstermiştir (p:0.023, p:0.017 ve p<0.001). Sonuç: PKG ile yönetilen KAH hastalarında, PHT, PKG sonrası TIMI akım ve ayrıca mevcut koroner ektazi varlığı, koroner no-reflow fenomeni olan hastalarda LVEF değerlerinden bağımsız olarak CI-AKI gelişimi için önemli bir risk oluşturmaktadır.

Anahtar Kelimeler:

Koroner arter hastalığı, kontrast ilişkili, no-reflow fenomeni, akut böbrek hasarı

Predictive Factors of Contrast-induced Acute Kidney Injury in the Setting of Coronary No-reflow Phenomenon

Introduction: In subjects undergoing percutaneous coronary intervention (PCI), coronary no-reflow phenomenon is generally determined through evaluation of TIMI (Thrombolysis In Myocardial Infarction) score. Contrast-induced acute kidney injury (CI-AKI) has also been a frequent problem in these patients. The purpose of this study is aimed to evaluate potential risk factors of CI-AKI in subjects with coronary no-reflow phenomenon. Methods: We enrolled consecutive patients with coronary artery disease (CAD) undergoing PCI between the years 2014 and 2019 in cardiology clinic. Independent variables associated with CI-AKI in patients with no reflow phenomenon following PCI were evaluated using multivariate logistic regression analysis. A p value <0.05 was accepted as the statistical significance limit. Results: Among a population of 3034 patients, 93 (3%) were diagnosed as having coronary no-reflow (64% male, mean age of 64±12 years). CI-AKI occurred in 22% of the patients with coronary no-reflow (n:20). The multivariate analysis has demonstrated significant associations of post PCI TIMI flow 0-1, contrast volume and pulmonary arterial hypertension (PHT) with the evolution of CI-AKI in the setting of no-reflow phenomenon (p:0.023, p:0.017 and p<0.001). Conclusion: In CAD patients managed with PCI, PHT, contrast volume, post-PCI TIMI flow as well as the presence of coronary ectasia may pose a significant risk for CI-AKI development in subjects with coronary no-reflow phenomenon.

Keywords:

Coronary artery disease, contrast-induced, no-reflow phenomenon, acute kidney injury,

PDF

___

1. Chawla, R., Turlington, J., Arora, P., & Jovin, I. S. Race and contrast-induced nephropathy in patients undergoing coronary angiography and cardiac catheterization. International journal of cardiology, 2017;230,610-613.
2. L. Bergamaschi, S. Avondo, S. Buratti, et al. No-reflow after primary percutaneous coronary interventions in STEMI is an independent predictor of contrast induced acute kidney injury, European Heart Journal, Volume 38, Issue suppl_1, August 2017, ehx502.P1393, https://doi.org/10.1093/eurheartj/ehx502.P1393.
3. Yuan, Y., Qiu, H., Hu, X. Y., et al. Relationship between high level of estimated glomerular filtration rate and contrast-induced acute kidney injury in patients who underwent an emergency percutaneous coronary intervention. Chinese medical journal, 2018;131:17,2041.
4. Van der Molen, A. J., Reimer, P., Dekkers, I. A., et al Post-contrast acute kidney injury–part 1: definition, clinical features, incidence, role of contrast medium and risk factors. European radiology, 2018;28(7), 2845-2855.
5. Diab, O. A., Helmy, M., Gomaa, Y., & El-Shalakany, R. Efficacy and safety of coronary sinus aspiration during coronary angiography to attenuate the risk of contrast-induced acute kidney injury in predisposed patients. Circulation: Cardiovascular Interventions, 2017;10:1,e004348.
6. Yilmaz, M. B., & Yalta, K. Coronary flow slows as renal function worsens. Clinical Cardiology: An International Indexed and Peer‐Reviewed Journal for Advances in the Treatment of Cardiovascular Disease, 2009;32:5,278-282.
7. Chatterjee, S., Kundu, A., Mukherjee, D., et al. Risk of contrast‐induced acute kidney injury in ST‐elevation myocardial infarction patients undergoing multi‐vessel intervention‐meta‐analysis of randomized trials and risk prediction modeling study using observational data. Catheterization and Cardiovascular Interventions, 2017;90:2,205-212.
8. Boztosun, B., Gunes, Y., & Kirma, C. No-reflow'a guncel yaklasim/Current management of no-reflow. The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi), 2006;6:3,255-261.
9. Celik, I. E., Kurtul, A., Duran, M., et al. Elevated serum fibrinogen levels and risk of contrast-induced acute kidney injury in patients undergoing a percutaneous coronary intervention for the treatment of acute coronary syndrome. Coronary artery disease, 2016;27:1,13-18.
10. ACT Investigators*. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation, 2011;124:11,1250-1259.
11. Stefanos Gr. Foussas. Acute Coronary Syndromes and Renal Disease, Hellenic Journal of Cardiology, 2016;57:3,210-213.
12. Rear, R., Bell, R. M., & Hausenloy, D. J. Contrast-induced nephropathy following angiography and cardiac interventions. Heart, 2016;102:8,638-648.
13. Bitker, L., Sens, F., Payet, C., et al. Presence of kidney disease as an outcome predictor in patients with pulmonary arterial hypertension. American journal of nephrology, 2018;47:2,134-143.
14. Velibey, Y., Oz, A., Tanik, O., et al. Platelet-to-lymphocyte ratio predicts contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Angiology, 2017;68:5,419-427.
15. Li, Y., & Ren, K. The Mechanism of Contrast-Induced Acute Kidney Injury and Its Association with Diabetes Mellitus. Contrast media & molecular imaging, 2020.
16. Azzalini, L., Spagnoli, V., & Ly, H. Q. Contrast-induced nephropathy: from pathophysiology to preventive strategies. Canadian Journal of Cardiology, 2016;32:2,247-255.