PCI complications: renal failure: Difference between revisions

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__NOTOC__
__NOTOC__
{{SI}}
{{PCI}}
'''Editors-In-Chief:''' Alexandra Almonacid M.D., Jeffrey J.Popma M.D.


'''Editors-In-Chief:''' Alexandra Almonacid M.D. and Jeffrey J.Popma M.D.
==Overview==
[[Acute kidney injury]] (AKI) occurs in approximately 7% of patients undergoing [[PCI]], of whom 3% develop [[AKI]] that requires [[dialysis]]. Increased occurrence of [[AKI]] among patients undergoing [[PCI]] is associated with the presence of [[STEMI]], preexisting baseline [[renal failure]] and [[cardiogenic shock]].  The occurrence of [[AKI]] following [[PCI]] is associated with increased in-hospital mortality.<ref name="pmid24456715">{{cite journal| author=Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME et al.| title=Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. | journal=JACC Cardiovasc Interv | year= 2014 | volume= 7 | issue= 1 | pages= 1-9 | pmid=24456715 | doi=10.1016/j.jcin.2013.06.016 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24456715  }} </ref>


== Incidence ==
==Renal Failure==
===Causes===
[[Renal dysfunction]] following [[contrast]] administration during [[angiography]] may relate to either [[contrast induced nephropathy]] ([[contrast induced nephropathy|CIN]]), [[cholesterol embolization syndrome]], or both. 
* [[Contrast induced nephropathy|Contrast Induced Nephropathy]]
** The risk of [[contrast induced nephropathy|CIN]] is dependent on the dose of the [[contrast agent]]s used, hydration status at the time of the procedure, pre-existing [[renal function]] of the patient, age, [[hemodynamic]] stability, [[anemia]], and [[diabetes]], and the risk for [[cholesterol embolization syndrome]] relates to catheter manipulation in an ascending or descending [[atherosclerotic]] [[aorta]] that releases [[cholesterol]] crystals.
** While the risk of [[hemodialysis]] is less than 3 percent in cases of uncomplicated [[contrast induced nephropathy|CIN]], the in-hospital [[mortality]] in the setting of [[hemodialysis]] exceeds 30 percent.


* The morbidity and mortality associated with PCI relates directly to the extent of baseline renal disease.
===Risk Factors===
* Patients with evidence of mild renal dysfunction have a 20 percent higher risk of death a one year following PCI than patients with preserved renal function (1-4).
* Mild renal dysfunction following PCI may increase the risk of death up to four fold at one year following PCI compared with patients with preserved renal function (1, 2, 4, 5).
*Worsening of renal function may occur after contrast agent administration in 13 to 20% of patients
*5% patient will have a 1 mg/dl increase of [[creatinine]] following angiography
*<1% chronic [[dialysis]]
== Etiology ==
Renal dysfunction following contrast administration during angiography may relate to either [[contrast induced nephropathy]] (CIN), [[cholesterol embolization syndrome]], or both. 
* '''Contrast Induced Nephropathy'''
** The risk of CIN is dependent on the dose of the contrast agents used, hydration status at the time of the procedure, pre-existing renal function of the patient, age, hemodynamic stability, anemia, and diabetes (1, 6), and the risk for cholesterol embolization syndrome relates to catheter manipulation in an ascending or descending atherosclerotic aorta that releases cholesterol crystals (7). 
** While the risk of [[hemodialysis]] is less than 3 percent in cases of uncomplicated CIN, the in-hospital mortality in the setting of hemodialysis exceeds 30 percent (5). 
===2011 ACCF/AHA Guidelines for Contrast-Induced Acute Kidney Injury<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83 |year=2011 |month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref> (DO  NOT EDIT)===
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''1.'''  Patients should be assessed for risk of [[Contrast induced nephropathy|contrast-induced acute kidney injury]] before PCI.<ref name="pmid15464318">{{cite journal |author=Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, Mintz GS, Lansky AJ, Moses JW, Stone GW, Leon MB, Dangas G |title=A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=7 |pages=1393–9 |year=2004 |month=October |pmid=15464318|doi=10.1016/j.jacc.2004.06.068|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)01445-7|accessdate=2011-12-06}}</ref><ref name="pmid16461821">{{cite journal |author=Moscucci M, Rogers EK, Montoye C, Smith DE, Share D, O'Donnell M, Maxwell-Eward A, Meengs WL, De Franco AC, Patel K, McNamara R, McGinnity JG, Jani SM, Khanal S, Eagle KA |title=Association of a continuous quality improvement initiative with practice and outcome variations of contemporary percutaneous coronary interventions |journal=[[Circulation]] |volume=113 |issue=6 |pages=814–22 |year=2006 |month=February|pmid=16461821 |doi=10.1161/CIRCULATIONAHA.105.541995|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16461821|accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''2.''' Patients undergoing cardiac catheterization with [[Contrast induced nephropathy#Choice of contrast agent|contrast media]] should receive adequate preparatory [[Contrast induced nephropathy#Hydration with or without bicarbonate|hydration]].<ref name="pmid15267006">{{cite journal |author=Bader BD, Berger ED, Heede MB, Silberbaur I, Duda S, Risler T, Erley CM |title=What is the best hydration regimen to prevent contrast media-induced nephrotoxicity? |journal=[[Clinical Nephrology]] |volume=62 |issue=1 |pages=1–7 |year=2004 |month=July |pmid=15267006 |doi= |url=|accessdate=2011-12-06}}</ref><ref name="pmid11822926">{{cite journal |author=Mueller C, Buerkle G, Buettner HJ, Petersen J, Perruchoud AP, Eriksson U, Marsch S, Roskamm H |title=Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty |journal=[[Archives of Internal Medicine]] |volume=162|issue=3 |pages=329–36 |year=2002 |month=February |pmid=11822926 |doi=|url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=11822926|accessdate=2011-12-06}}</ref><ref name="pmid7969280">{{cite journal |author=Solomon R, Werner C, Mann D, D'Elia J, Silva P |title=Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents |journal=[[The New England Journal of Medicine]] |volume=331 |issue=21 |pages=1416–20 |year=1994 |month=November |pmid=7969280|doi=10.1056/NEJM199411243312104 |url=http://dx.doi.org/10.1056/NEJM199411243312104|accessdate=2011-12-06}}</ref><ref name="pmid12411756">{{cite journal |author=Trivedi HS, Moore H, Nasr S, Aggarwal K, Agrawal A, Goel P, Hewett J |title=A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity |journal=[[Nephron. Clinical Practice]] |volume=93 |issue=1 |pages=C29–34 |year=2003 |month=January |pmid=12411756 |doi= |url=|accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|
<nowiki>"</nowiki>'''3.''' In patients with [[Chronic kidney disease|chronic kidney disease (CKD)]] ([[creatinine clearance]] ≤60 mL/min), the volume of [[Contrast induced nephropathy#Choice of contrast agent|contrast media]] should be minimized.<ref name="pmid19189906">{{cite journal |author=Marenzi G, Assanelli E, Campodonico J, Lauri G, Marana I, De Metrio M, Moltrasio M, Grazi M, Rubino M, Veglia F, Fabbiocchi F, Bartorelli AL |title=Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality |journal=[[Annals of Internal Medicine]] |volume=150 |issue=3 |pages=170–7 |year=2009 |month=February |pmid=19189906 |doi= |url=|accessdate=2011-12-06}}</ref><ref name="pmid9375704">{{cite journal |author=McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW |title=Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality |journal=[[The American Journal of Medicine]]|volume=103 |issue=5 |pages=368–75 |year=1997 |month=November |pmid=9375704 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(97)00150-2|accessdate=2011-12-06}}</ref><ref name="pmid8589322">{{cite journal |author=Russo D, Minutolo R, Cianciaruso B, Memoli B, Conte G, De Nicola L |title=Early effects of contrast media on renal hemodynamics and tubular function in chronic renal failure |journal=[[Journal of the American Society of Nephrology : JASN]] |volume=6 |issue=5 |pages=1451–8 |year=1995 |month=November|pmid=8589322 |doi= |url=http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=8589322|accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
 
==Risk Factors==
*Prior [[renal insufficiency]]
*Prior [[renal insufficiency]]
*[[Diabetes Mellitus]]
*[[Diabetes Mellitus]]
*Dehydration before the procedure  
*[[Dehydration]] before the procedure  
*[[Congestive Heart Failure]]
*[[Congestive Heart Failure]]
*Larger volumes of contrast material
*Larger volumes of [[contrast]] material
*[[Nephrotoxic]] drugs
*[[Nephrotoxic]] drugs
*Recent (<48 hour) contrast exposure.
*Recent (<48 hour) [[contrast]] exposure.


==Toxicities Associated with Radiocontrast Agents==  
===Natural History, Complications and Prognosis===
====Prognosis====
* The [[morbidity]] and [[mortality]] associated with PCI relates directly to the extent of baseline [[renal disease]].
* Patients with evidence of mild [[renal dysfunction]] have a 20 percent higher risk of death a one year following PCI than patients with preserved [[renal function]].
* Mild [[renal dysfunction]] following PCI may increase the risk of death up to four fold at one year following PCI compared with patients with preserved [[renal function]].
*Worsening of [[renal function]] may occur after [[contrast agent]] administration in 13 to 20% of patients.
*5% patient will have a 1 mg/dl increase of [[creatinine]] following [[angiography]].
*<1% [[chronic]] [[dialysis]].
===Toxicities Associated with Radiocontrast Agents===  
*Allergic ([[anaphylactoid]]) reactions
*Allergic ([[anaphylactoid]]) reactions
**Grade I: Single episode of [[emesis]], nausea, sneezing, or [[vertigo]]
**Grade I: Single episode of [[emesis]], [[nausea]], [[sneezing]], or [[vertigo]]
**Grade II: [[Hives]], multiple episodes of emesis, fevers, or chills
**Grade II: [[Hives]], multiple episodes of [[emesis]], [[fever]]s, or [[chills]]
**Grade III: Clinical shock, [[bronchospasm]], [[laryngospasm]] or edema, loss of consciousness, hypotension, hypertension, cardiac arrhythmia, [[angioedema]], or [[pulmonary edema]]
**Grade III: Clinical [[shock]], [[bronchospasm]], [[laryngospasm]] or [[edema]], [[loss of consciousness]], [[hypotension]], [[hypertension]], [[cardiac arrhythmia]], [[angioedema]], or [[pulmonary edema]]
*Cardiovascular toxicity
*[[Cardiovascular]] [[toxicity]]
**Electrophysiologic
**[[Electrophysiologic study|Electrophysiologic]]
***[[Bradycardia]] ([[asystole]], heart block)
***[[Bradycardia]] ([[asystole]], [[heart block]])
***[[Tachycardia]] (sinus, ventricular)
***[[Tachycardia]] ([[sinus tachycardia|sinus]], [[ventricular tachycardia|ventricular]])
***[[Ventricular fibrillation]]
***[[Ventricular fibrillation]]
**Hemodynamic
**[[Hemodynamic]]
***[[Hypotension]] (cardiac depression, vasodilation)
***[[Hypotension]] ([[cardiac]] depression, [[vasodilation]])
***Heart failure (cardiac depression, increased intravascular volume)
***[[Heart failure]] ([[cardiac]] depression, increased [[intravascular]] volume)
*[[Nephrotoxicity]]
*[[Nephrotoxicity]]
*Discomfort
*Discomfort
**Nausea  
**[[Nausea]]
**Vomiting
**[[Vomiting]]
**Heat and flushing
**Heat and flushing
*[[Hyperthyroidism]]
*[[Hyperthyroidism]]
==2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24|pages=2550–83 |year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
===Contrast-Induced Acute Kidney Injury (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''  Patients should be assessed for risk of [[Contrast induced nephropathy|contrast-induced acute kidney injury]] before PCI.<ref name="pmid15464318">{{cite journal |author=Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, Mintz GS, Lansky AJ, Moses JW, Stone GW, Leon MB, Dangas G |title=A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=7 |pages=1393–9|year=2004 |month=October|pmid=15464318|doi=10.1016/j.jacc.2004.06.068|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)01445-7|accessdate=2011-12-06}}</ref><ref name="pmid16461821">{{cite journal |author=Moscucci M, Rogers EK, Montoye C, Smith DE, Share D, O'Donnell M, Maxwell-Eward A, Meengs WL, De Franco AC, Patel K, McNamara R, McGinnity JG, Jani SM, Khanal S, Eagle KA |title=Association of a continuous quality improvement initiative with practice and outcome variations of contemporary percutaneous coronary interventions |journal=[[Circulation]] |volume=113 |issue=6|pages=814–22 |year=2006 |month=February|pmid=16461821 |doi=10.1161/CIRCULATIONAHA.105.541995|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16461821|accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Patients undergoing [[cardiac catheterization]] with [[Contrast induced nephropathy#Choice of contrast agent|contrast media]] should receive adequate preparatory [[Contrast induced nephropathy#Hydration with or without bicarbonate|hydration]].<ref name="pmid15267006">{{cite journal |author=Bader BD, Berger ED, Heede MB, Silberbaur I, Duda S, Risler T, Erley CM |title=What is the best hydration regimen to prevent contrast media-induced nephrotoxicity? |journal=[[Clinical Nephrology]] |volume=62 |issue=1 |pages=1–7 |year=2004|month=July |pmid=15267006 |doi= |url=|accessdate=2011-12-06}}</ref><ref name="pmid11822926">{{cite journal |author=Mueller C, Buerkle G, Buettner HJ, Petersen J, Perruchoud AP, Eriksson U, Marsch S, Roskamm H |title=Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty |journal=[[Archives of Internal Medicine]]|volume=162|issue=3 |pages=329–36 |year=2002 |month=February |pmid=11822926 |doi=|url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=11822926|accessdate=2011-12-06}}</ref><ref name="pmid7969280">{{cite journal |author=Solomon R, Werner C, Mann D, D'Elia J, Silva P |title=Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents|journal=[[The New England Journal of Medicine]] |volume=331 |issue=21 |pages=1416–20 |year=1994 |month=November|pmid=7969280|doi=10.1056/NEJM199411243312104 |url=http://dx.doi.org/10.1056/NEJM199411243312104|accessdate=2011-12-06}}</ref><ref name="pmid12411756">{{cite journal |author=Trivedi HS, Moore H, Nasr S, Aggarwal K, Agrawal A, Goel P, Hewett J |title=A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity |journal=[[Nephron. Clinical Practice]]|volume=93 |issue=1 |pages=C29–34 |year=2003 |month=January |pmid=12411756 |doi= |url=|accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' In patients with [[Chronic kidney disease|chronic kidney disease (CKD)]] ([[creatinine clearance]] ≤60 mL/min), the volume of [[Contrast induced nephropathy#Choice of contrast agent|contrast media]] should be minimized.<ref name="pmid19189906">{{cite journal|author=Marenzi G, Assanelli E, Campodonico J, Lauri G, Marana I, De Metrio M, Moltrasio M, Grazi M, Rubino M, Veglia F, Fabbiocchi F, Bartorelli AL |title=Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality |journal=[[Annals of Internal Medicine]] |volume=150 |issue=3 |pages=170–7 |year=2009 |month=February |pmid=19189906 |doi=|url=|accessdate=2011-12-06}}</ref><ref name="pmid9375704">{{cite journal |author=McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW|title=Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality |journal=[[The American Journal of Medicine]]|volume=103 |issue=5 |pages=368–75 |year=1997 |month=November |pmid=9375704|doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(97)00150-2|accessdate=2011-12-06}}</ref><ref name="pmid8589322">{{cite journal |author=Russo D, Minutolo R, Cianciaruso B, Memoli B, Conte G, De Nicola L |title=Early effects of contrast media on renal hemodynamics and tubular function in chronic renal failure |journal=[[Journal of the American Society of Nephrology : JASN]] |volume=6|issue=5 |pages=1451–8 |year=1995 |month=November|pmid=8589322 |doi= |url=http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=8589322|accessdate=2011-12-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
{| class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Administration of N-acetyl-L-[[cysteine]] is not useful for the prevention of [[contrast]]-induced [[acute kidney injury]].<ref> Gonzales DA, Norsworthy KJ, Kern SJ, et al. A meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneity. BMC Med. 2007; 5: 32. Published online November 14, 2007. doi:10.1186/1741-7015-5-32</ref><ref>Ozcan EE, Guneri S, Akdeniz B, et al. Sodium bicarbonate, N-acetylcysteine, and saline for prevention of radiocontrast-induced nephropathy. A comparison of 3 regimens for protecting contrast-induced nephropathy in patients undergoing coronary procedures. A single-center prospective controlled trial. Am Heart J. 2007; 154: 539– 44.</ref> <ref>Thiele H, Hildebrand L, Schirdewahn C, et al. Impact of high-dose N-acetylcysteine versus placebo on contrast-induced nephropathy and myocardial reperfusion injury in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the LIPSIA-N-ACC (Prospective, Single-Blind, Placebo-Controlled, Randomized Leipzig Immediate PercutaneouS Coronary Intervention Acute Myocardial Infarction N-ACC) Trial. J Am Coll Cardiol. 2010; 55: 2201– 9.</ref><ref>Webb JG, Pate GE, Humphries KH, et al. A randomized controlled trial of intravenous N-acetylcysteine for the prevention of contrast-induced nephropathy after cardiac catheterization: lack of effect. Am Heart J. 2004; 148: 422–9.</ref><ref>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: 1250–9.</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|}
===PCI in Chronic Kidney Disease (DO NOT EDIT)<ref name="pmid22070837">{{cite journal|author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]]|volume=58 |issue=24 |pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In patients undergoing PCI, the [[glomerular filtration rate]] should be estimated and the dosage of renally cleared medications should be adjusted.<ref name="pmid16908915">{{cite journal |author=Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F |title=Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate|journal=[[Annals of Internal Medicine]] |volume=145 |issue=4 |pages=247–54|year=2006 |month=August|pmid=16908915 |doi= |url= |accessdate=2011-12-15}}</ref><ref name="pmid19446939">{{cite journal|author=Stevens LA, Nolin TD, Richardson MM, Feldman HI, Lewis JB, Rodby R, Townsend R, Okparavero A, Zhang YL, Schmid CH, Levey AS |title=Comparison of drug dosing recommendations based on measured GFR and kidney function estimating equations |journal=[[American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation]] |volume=54 |issue=1 |pages=33–42 |year=2009|month=July |pmid=19446939 |pmc=2756662|doi=10.1053/j.ajkd.2009.03.008|url=http://linkinghub.elsevier.com/retrieve/pii/S0272-6386(09)00601-5|accessdate=2011-12-15}}</ref><ref name="pmid19776297">{{cite journal |author=Hassan Y, Al-Ramahi RJ, Aziz NA, Ghazali R |title=Impact of a renal drug dosing service on dose adjustment in hospitalized patients with chronic kidney disease |journal=[[The Annals of Pharmacotherapy]]|volume=43 |issue=10 |pages=1598–605|year=2009 |month=October |pmid=19776297 |doi=10.1345/aph.1M187|url=http://www.theannals.com/cgi/pmidlookup?view=long&pmid=19776297|accessdate=2011-12-15}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}


==References==  
==References==  
{{reflist|2}}
{{reflist|2}}
#ref1 PMID 16489569
[[Category:Up-To-Date]]
#ref2 PMID 15957128
[[Category:Up-To-Date cardiology]]
#ref3 PMID 12943868
#ref4 PMID 15864241
#ref5 PMID 12010907
#ref6 PMID 15619387
#ref7 PMID 12875753
 
 
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Latest revision as of 14:32, 10 March 2014

Percutaneous coronary intervention Microchapters

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Restenosis
Renal Failure
Thrombocytopenia
Late Acquired Stent Malapposition
Loss of Side Branch
Multiple Complications

PCI in Specific Patients

Cardiogenic Shock
Left Main Coronary Artery Disease
Refractory Ventricular Arrhythmia
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Sole Remaining Conduit
Unprotected Left Main Patient
Adjuncts for High Risk PCI

PCI in Specific Lesion Types

Classification of the Lesion
The Calcified Lesion
The Ostial Lesion
The Angulated or Tortuous Lesion
The Bifurcation Lesion
The Long Lesion
The Bridge Lesion
Vasospasm
The Chronic Total Occlusion
The Left Internal Mammary Artery
Multivessel Disease
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The Thrombotic Lesion

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Editors-In-Chief: Alexandra Almonacid M.D., Jeffrey J.Popma M.D.

Overview

Acute kidney injury (AKI) occurs in approximately 7% of patients undergoing PCI, of whom 3% develop AKI that requires dialysis. Increased occurrence of AKI among patients undergoing PCI is associated with the presence of STEMI, preexisting baseline renal failure and cardiogenic shock. The occurrence of AKI following PCI is associated with increased in-hospital mortality.[1]

Renal Failure

Causes

Renal dysfunction following contrast administration during angiography may relate to either contrast induced nephropathy (CIN), cholesterol embolization syndrome, or both.

Risk Factors

Natural History, Complications and Prognosis

Prognosis

Toxicities Associated with Radiocontrast Agents

2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[2]

Contrast-Induced Acute Kidney Injury (DO NOT EDIT)[2]

Class I
"1. Patients should be assessed for risk of contrast-induced acute kidney injury before PCI.[3][4] (Level of Evidence: C)"
"2. Patients undergoing cardiac catheterization with contrast media should receive adequate preparatory hydration.[5][6][7][8] (Level of Evidence: B)"
"3. In patients with chronic kidney disease (CKD) (creatinine clearance ≤60 mL/min), the volume of contrast media should be minimized.[9][10][11] (Level of Evidence: B)"
Class III (No Benefit)
"1. Administration of N-acetyl-L-cysteine is not useful for the prevention of contrast-induced acute kidney injury.[12][13] [14][15][16] (Level of Evidence: A)"

PCI in Chronic Kidney Disease (DO NOT EDIT)[2]

Class I
"1. In patients undergoing PCI, the glomerular filtration rate should be estimated and the dosage of renally cleared medications should be adjusted.[17][18][19] (Level of Evidence: B)"

References

  1. ↑ Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME; et al. (2014). "Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry". JACC Cardiovasc Interv. 7 (1): 1–9. doi:10.1016/j.jcin.2013.06.016. PMID 24456715.
  2. ↑ 2.0 2.1 2.2 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter |month= ignored (help)
  3. ↑ Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, Mintz GS, Lansky AJ, Moses JW, Stone GW, Leon MB, Dangas G (2004). "A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation". Journal of the American College of Cardiology. 44 (7): 1393–9. doi:10.1016/j.jacc.2004.06.068. PMID 15464318. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  4. ↑ Moscucci M, Rogers EK, Montoye C, Smith DE, Share D, O'Donnell M, Maxwell-Eward A, Meengs WL, De Franco AC, Patel K, McNamara R, McGinnity JG, Jani SM, Khanal S, Eagle KA (2006). "Association of a continuous quality improvement initiative with practice and outcome variations of contemporary percutaneous coronary interventions". Circulation. 113 (6): 814–22. doi:10.1161/CIRCULATIONAHA.105.541995. PMID 16461821. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  5. ↑ Bader BD, Berger ED, Heede MB, Silberbaur I, Duda S, Risler T, Erley CM (2004). "What is the best hydration regimen to prevent contrast media-induced nephrotoxicity?". Clinical Nephrology. 62 (1): 1–7. PMID 15267006. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  6. ↑ Mueller C, Buerkle G, Buettner HJ, Petersen J, Perruchoud AP, Eriksson U, Marsch S, Roskamm H (2002). "Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty". Archives of Internal Medicine. 162 (3): 329–36. PMID 11822926. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  7. ↑ Solomon R, Werner C, Mann D, D'Elia J, Silva P (1994). "Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents". The New England Journal of Medicine. 331 (21): 1416–20. doi:10.1056/NEJM199411243312104. PMID 7969280. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  8. ↑ Trivedi HS, Moore H, Nasr S, Aggarwal K, Agrawal A, Goel P, Hewett J (2003). "A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity". Nephron. Clinical Practice. 93 (1): C29–34. PMID 12411756. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  9. ↑ Marenzi G, Assanelli E, Campodonico J, Lauri G, Marana I, De Metrio M, Moltrasio M, Grazi M, Rubino M, Veglia F, Fabbiocchi F, Bartorelli AL (2009). "Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality". Annals of Internal Medicine. 150 (3): 170–7. PMID 19189906. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  10. ↑ McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW (1997). "Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality". The American Journal of Medicine. 103 (5): 368–75. PMID 9375704. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  11. ↑ Russo D, Minutolo R, Cianciaruso B, Memoli B, Conte G, De Nicola L (1995). "Early effects of contrast media on renal hemodynamics and tubular function in chronic renal failure". Journal of the American Society of Nephrology : JASN. 6 (5): 1451–8. PMID 8589322. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  12. ↑ Gonzales DA, Norsworthy KJ, Kern SJ, et al. A meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneity. BMC Med. 2007; 5: 32. Published online November 14, 2007. doi:10.1186/1741-7015-5-32
  13. ↑ Ozcan EE, Guneri S, Akdeniz B, et al. Sodium bicarbonate, N-acetylcysteine, and saline for prevention of radiocontrast-induced nephropathy. A comparison of 3 regimens for protecting contrast-induced nephropathy in patients undergoing coronary procedures. A single-center prospective controlled trial. Am Heart J. 2007; 154: 539– 44.
  14. ↑ Thiele H, Hildebrand L, Schirdewahn C, et al. Impact of high-dose N-acetylcysteine versus placebo on contrast-induced nephropathy and myocardial reperfusion injury in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the LIPSIA-N-ACC (Prospective, Single-Blind, Placebo-Controlled, Randomized Leipzig Immediate PercutaneouS Coronary Intervention Acute Myocardial Infarction N-ACC) Trial. J Am Coll Cardiol. 2010; 55: 2201– 9.
  15. ↑ Webb JG, Pate GE, Humphries KH, et al. A randomized controlled trial of intravenous N-acetylcysteine for the prevention of contrast-induced nephropathy after cardiac catheterization: lack of effect. Am Heart J. 2004; 148: 422–9.
  16. ↑ 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: 1250–9.
  17. ↑ Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F (2006). "Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate". Annals of Internal Medicine. 145 (4): 247–54. PMID 16908915. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  18. ↑ Stevens LA, Nolin TD, Richardson MM, Feldman HI, Lewis JB, Rodby R, Townsend R, Okparavero A, Zhang YL, Schmid CH, Levey AS (2009). "Comparison of drug dosing recommendations based on measured GFR and kidney function estimating equations". American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 54 (1): 33–42. doi:10.1053/j.ajkd.2009.03.008. PMC 2756662. PMID 19446939. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  19. ↑ Hassan Y, Al-Ramahi RJ, Aziz NA, Ghazali R (2009). "Impact of a renal drug dosing service on dose adjustment in hospitalized patients with chronic kidney disease". The Annals of Pharmacotherapy. 43 (10): 1598–605. doi:10.1345/aph.1M187. PMID 19776297. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)

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