Andrés F. Ochoa-Díaz, Departamento de Medicina Interna, Universidad Industrial de Santander, Bucaramanga, Colombia
Claudia L. Figueroa-Pineda, Departamento de Medicina Interna, Universidad Industrial de Santander, Bucaramanga, Colombia
Boris E. Vesga-Angarita, Departamento de Medicina Interna, Universidad Industrial de Santander; Departamento de Cardiología Intervencionista, Instituto del Corazón de Bucaramanga. Bucaramanga, Colombia
Introduction: Patients with acute coronary syndrome and renal dysfunction are more likely to develop contrast-induced nephropathy after coronary angiography, which in turn increases in-hospital mortality. ST elevation myocardial infarction and left ventricular dysfunction are predictors of mortality in this scenario. Objective: To describe the clinical characteristics of patients with acute coronary syndrome and renal dysfunction who presented contrast-induced nephropathy (CIN) after coronary arteriography, its predictors of onset, and in-hospital mortality in a Colombian population. Methods: Cross-sectional analytical observational study of patients ≥ 18 years with acute coronary syndrome, glomerular filtration rate < 60 ml/min/1.73 m2 or criteria for acute renal failure, undergoing coronary angiography at a cardiovascular institute in Bucaramanga between 2019 and 2020, who developed contrast-induced nephropathy within 3-5 days after the index procedure. Results: 210 patients were included, 10.4% developed contrast-induced nephropathy. The 81.8% were men, average age 72 years. Systemic arterial hypertension, diabetes mellitus and chronic kidney disease were the most frequent antecedents. The anterior descending artery was the most compromised. ST elevation myocardial infarction [OR = 3, confidence interval (CI) 95% = 1.0-8.9; p=0.04), history of chronic kidney disease (OR = 3.4; CI 95% = 1.2-9.2; p = 0.01), and systolic blood pressure ≤ 130 mmHg during angiography (OR = 4.1; CI 95% = 1.5-11.3; p = 0.006) were associated with contrast-induced nephropathy (area under 0.76). ST elevation myocardial infarction (OR = 10.2; CI 95% = 2.6-38.6; p = 0.001), the presence of contrast-induced nephropathy (OR = 4.8; CI 95% = 1.2-19.4; p = 0.026), and LVEF ≤ 40% (OR = 4.2; CI 95% = 1.1-16.1; p = 0.032) were associated with in-hospital mortality (Receiver operating characteristic [ROC] curve of 0.87). Conclusions: Contrast-induced nephropathy, ST elevation myocardial infarction and left ventricular dysfunction in patients with renal dysfunction were associated with a higher risk of in-hospital mortality.
Keywords: Coronary angiography. Renal insufficiency. Acute coronary syndrome. Hospital mortality. Contrast induced nephropathy.
