What factors are Associated with the Development of Contras-induced Nephropathy in Elderly Patients with Acute Coronary Syndrome in Real Clinical Practice?

• Published in: Rat͡s︡ionalʹnai͡a︡ farmakoterapii͡a︡ v kardiologii Vol. 16; no. 6; pp. 908 - 915
• Main Authors: Gilyarov, M. Yu, Konstantinova, E. V., Kovalets, P. V., Slivin, A. V., Udovichenko, A. E., Nesterov, A. P., Svetlova, O. N., Svet, A. V.
• Format: Journal Article
• Language: English
• Published: Столичная издательская компания 30.12.2020
• Subjects: acute coronary syndrome; contrast-induced acute kidney injury; death rate; elderly patients; risk factors
• ISSN: 1819-6446; 2225-3653
• DOI: 10.20996/1819-6446-2020-12-02

Aim . To study the factors associated with contrast-induced acute kidney injury in elderly patients with acute coronary syndrome (ACS). Material and Methods . A retrospective analysis of 514 electronic medical records of patients aged 75 years and over (38% men and 62% women) with confirmed acute coronary syndrome has been performed. The contrast-induced acute kidney injury was defined as an increase in serum creatinine ≥26.5 μmol/L in 48 h or as an increase in serum creatinine in 1.5 times within 7 days after the contrast media exposure. Patients were divided into contrast-induced acute kidney injury and non-contrast-induced acute kidney injury group. Clinical characteristics and in-hospital outcomes were extracted from patients' medical records. Procedural characteristics were obtained from laboratory database. Results . Angiographic intervention was performed in 74% of patients, 32% of them (more often in women, p=0.033) were diagnosed with contrast-induced acute kidney injury. Patients with contrast-induced acute kidney injury are characterized by a higher death rate (17% и 3%, p<0.001) and were more likely to have heart failure with reduced ejection fraction (34% и 21%, p=0.008) and acute heart failure (Killip class II-IV) (24% и 16%, p=0.015). The risk of developing contrast-induced acute kidney injury was related the volume of contrast medium administered. Conclusions . Prevention particular care should be taken to female patients older than 75 years with ACS, with a history of the chronic heart failure with reduced ejection fraction or acute heart failure (Killip class II-IV), and with a high volume of contrast media, highlighting that a perioperative comprehensive management strategy is needed to improve the prognosis.