超音波、動脈硬化、心電図など統合一元化できます

超音波、動脈硬化、心電図など統合一元化できます

2009年11月8日日曜日

血管造影剤が腎臓病、糖尿病へ影響がある

Clin Res Cardiol
Contrast medium induced nephropathy in patients undergoing
percutaneous coronary intervention for acute coronary syndrome:
differences in STEMI and NSTEMI

Ingo Wickenbrock .
Christian Perings .
Petra Maagh .
Received: 24 March 2009 / Accepted: 30 July 2009

Abstract The aim of this study was to assess the incidence,
clinical predictors, and outcome of patients developing
contrast medium induced nephropathy (CIN) after
percutaneous coronary intervention (PCI) for acute coronary
syndrome (ACS).
Background CIN is associated with significant higher
morbidity and mortality after coronary intervention.
Recently it was shown, that patients undergoing percutaneous
coronary intervention for acute myocardial infarction
have a significant higher risk of developing CIN. NonST-
elevating myocardial infarction (NSTEMI) patients
(pts) might be at an even higher risk developing CIN than
patients with ST-elevating myocardial infarction (STEMI),
because of presenting older and more often with diabetes.
Methods In 392 consecutive ACS patients developing
myocardial infarction and therefore undergoing emergent
coronary angiography between October 2004 and March

Department of Cardiology and Pneumology, St. Marien Hospital
Lu¨nen, Academic Teaching Hospital of the University
of Mu¨nster, Lu¨nen, Germany
Department of Cardiology and Angiology,
Ruhr University of Bochum, Bochum, Germany
Department of Nephrology, University of Du¨sseldorf,
Du¨sseldorf, Germany
Department of Cardiology,
Pneumology, Nephrology and Intensive Care Medicine,
Klinikum Lu¨nen, St. Marien Hospital Lu¨nen,
Altstadtstr. 23, Lu¨nen 44534, Germany
e-mail: wickenbrock.ingo@smh-online.de
we measured serum creatinine concentration (Cr) at
baseline and each day of the following 3 days. Contrast
medium induced nephropathy was defined as an increase in
Cr [ 0.5 mg/dl. ACS was defined according to the guidelines
of the German Society of Cardiology.
Results Overall, 392 pts were included: 203 (51.8%) with
STEMI and 189 (48.2%) with NSTEMI. Patients with STEMI
developed more often a cardiogenic shock (18 vs. 6%;
P \ 0.001) whereas patients with NSTEMI were older (67 vs.
61 years; P \ 0.001) and presenting with a higher co-morbidity.
Forty-five (11.5%) pts developed CIN; 22 (10.8%) in
the STEMI group and 23(12.2%) in the NSTEMI group
(P = 0.75). Patients developing CIN presented a more complicated
clinical course and a significantly longer hospital stay
(14 vs. 10 days; P \ 0.001). The mortality rate was also
significantly higher (16 vs. 6%; P \0.05).
Conclusion This prospective study showed no differences
in the incidence of developing CIN in patients undergoing PCI
for STEMI or NSTEMI, but the predisposing factors, however,
differed significantly. Although STEMI patients needed
significantly more contrast medium for revascularisation, they
did not develop CIN more often. CIN was associated with
higher in-hospital complication rate and mortality. Thus,
better preventive strategies according to the different predisposing
factors leading to CIN are needed to reduce morbidity
and mortality, especially in high risk patients.

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