Association of contrast-induced nephropathy with risk of adverse clinical outcomes in patients with cardiac catheterization: From the CINC-J study

作者：Sato Akira^*; Aonuma Kazutaka; Watanabe Makoto; Hirayama Atsushi; Tamaki Nagara; Tsutsui Hiroyuki; Murohara Toyoaki; Ogawa Hisao; Akasaka Takashi; Yoshimura Michihiro; Takayama Tadateru; Sakakibara Mamoru; Suzuki Susumu; Ishigami Kenichi; Onoue Kenji; Saito Yoshihiko

来源：International Journal of Cardiology, 2017, 227: 424-429.

DOI：10.1016/j.ijcard.2016.11.019

• Contrast-induced nephropathy
• Coronary angiography
• Prognosis

Background: The association between the incidence of contrast-induced nephropathy ((IN) and subsequent clinical outcomes is unclear in Japan. We evaluated the association between CIN and cardiovascular and renal events after cardiac catheterization.
Methods: The CINC-J multicenter prospective cohort study examined 853 patients undergoing cardiac catheterization from 27 hospitals. CIN was defined as increase in serum creatinine (SCr) >= 0.5 mg/dL or >= 25% from baseline between 48 and 72 h after exposure to contrast. Major adverse cardiovascular and cerebrovascular events (MACCE) included all-cause deaths, non-fatal myocardial infarction, acute decompensated heart failure (ADHF), and stroke. Renal events included newly-required hemodialysis and increase of SCr >= 2 x from baseline.
Results: During follow-up periods (477 +/- 214 days), CIN, MACCE, and renal events occurred in 44 (5.2%), 71 (8.3%), and 26 (3.0%) patients, respectively. Kaplan-Meier analysis showed that CIN yielded increasing risk for MACCE, ADHF, newly-required hemodialysis, and renal events. In multivariable Cox proportional hazards analysis, age (HR: 1.03; 95%CI, 1.00-1.07; P = 0.0425), anemia (HR: 1.94; 95% CI, 1.08-3.61; P = 0.0264), and diabetes mellitus (HR: 1.86; 95% CI, 1.10-3.21; P = 0.0119) were independent predictors of MACCE, whereas CIN (HR: 7.78; 95% CI, 3.23-17.9; P = 0.0005) and SCr (HR: 2.09; 95%. CI, 1.56-2.73; P = 0.0006) were independent predictors of renal events. Compared to subjects without both anemia and CIN as the reference, those with both were high risk for MACCE (HR: 3.97; 95% CI, 125-10.6; P = 0.0218).
Conclusion: CIN was a significant predictor of subsequent renal events after cardiac catheterization. ON and anemia were associated with increased risk for worse long-term clinical outcome, especially when both were present.

• 出版日期2017-1-15