Preventive effect of statin pretreatment on contrast-induced acute kidney injury in patients undergoing coronary angioplasty: Propensity score analysis from a multicenter registry

BackgroundThe prophylactic benefit of statins in reducing the incidence of contrast-induced acute kidney injury (CI-AKI) has been investigated in several studies with conflicting results. We sought to investigate whether statin pretreatment prevents CI-AKI in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI).MethodsA total of 2198 CAD patients who underwent PCI, except for those undergoing dialysis or who died within 7 days after angioplasty, were analyzed from the ICAS (Ibaraki Cardiovascular Assessment Study) multicenter registry. Analyzed subjects were divided into 2 groups according to statin pretreatment: statin pretreatment (n = 839) and non-statin pretreatment (n = 1359). Selection bias of statin pretreatment was adjusted by propensity score-matching method: pretreatment statin (n = 565) and non-statin pretreatment (n = 565). CI-AKI was defined as an increase in serum creatinine of ≥ 25% or 0.5 mg/dl from baseline within 1 week of contrast medium exposure.ResultsA total of 192 (8.7%) patients developed CI-AKI. No significant differences were observed in baseline patient characteristics between the statin and non-statin pretreatment groups after propensity score matching. In the propensity score-matched groups, the incidence of CI-AKI was significantly lower in patients with statin pretreatment than in those without statin pretreatment (3.5% vs.10.6%, odds ratio [OR]: 0.31, 95% confidence interval [CI]: 0.18–0.52, P < 0.001). Multivariate logistic regression analysis showed that statin pretreatment remained an independent negative predictor of CI-AKI (OR: 0.31, 95% CI: 0.18–0.53, P < 0.001) among propensity score-matched subjects.ConclusionsStatin pretreatment was associated with a significant decrease in the risk of CI-AKI in CAD patients undergoing PCI in the ICAS Registry

シンキン バイアビリティ ケンシュツ ニオケル テイヨウリョウ ドブタミン フカ シン プールシンチグラフィ ノ ヒョウカ : サシツ キョクショ シンキノウ テイリョウ カイセキ オ モチイテ

筑波大学博士 (医学) 学位論文・平成13年4月30日授与 (乙第1735号)付: 参考文

Effect of the Mehran risk score for the prediction of clinical outcomes after percutaneous coronary intervention

AbstractBackgroundThe association of Mehran risk score (MRS) with long-term prognosis in patients treated with percutaneous coronary intervention (PCI) has not been fully reported. We investigated the association between MRS and clinical outcomes in patients who underwent PCI.MethodsStudy subjects comprised 2198 patients treated with PCI from the Ibaraki Cardiovascular Assessment Study multicenter registry, excluding patients receiving hemodialysis or who died within 7 days. We categorized them into 4 groups according to MRS (low-risk: ≤5; medium-risk: 6–10; high-risk: 11–16; and very high-risk: ≥16). Contrast-induced acute kidney injury (CI-AKI) was defined as an increase of 0.5mg/dL or 25% in pre-PCI serum creatinine within 1-week post procedure. We evaluated CI-AKI and major adverse cardiac and cerebrovascular events (MACCE), and defined as all-cause death, myocardial infarction, congestive heart failure, or cerebrovascular disorder (stroke or transient ischemic attack).ResultsA total of 192 (8.7%) patients developed CI-AKI. At multivariate analysis, odds ratio for CI-AKI was 4.09 (95% CI: 1.72–9.17, p=0.002) in the very high-risk group, 1.49 (95% CI: 0.89–2.42, p=0.120) in the high-risk group, and 1.08 (95% CI: 0.74–1.54, p=0.693) in the medium-risk group, as compared with the low-risk group. MACCE in the very high-risk group was more than 5-fold higher [hazard ratio (HR) 5.40, 95% CI: 2.96–9.28, p<0.001] compared with the low-risk group and was also increased in the high-risk (HR 3.72, CI: 2.59–5.32, p<0.001) and medium-risk groups (HR 1.97, CI: 1.45–2.69, p<0.001). Kaplan–Meier analysis showed that increasing risk for MACCE was seen across the groups as MRS increased (p<0.001).ConclusionMRS might provide potentially useful information for prediction of CI-AKI and clinical outcomes after PCI

Predictors of Recurrence after Catheter Ablation of Paroxysmal Atrial Fibrillation in Different Follow-Up Periods

Background and objectives: Pulmonary vein (PV) reconnection is a major reason for recurrence after catheter ablation of paroxysmal atrial fibrillation (PAF). However, the timing of the recurrence varies between patients, and recurrence &gt;1 year after ablation is not uncommon. We sought to elucidate the characteristics of atrial fibrillation (AF) that recurred in different follow-up periods. Materials and Methods: Study subjects comprised 151 consecutive patients undergoing initial catheter ablation of PAF. Left atrial volume index (LAVi) and atrial/brain natriuretic peptide (ANP/BNP) levels were systematically measured annually over 3 years until AF recurred. Results: Study subjects were classified into four groups: non-recurrence group (n = 84), and short-term- (within 1 year) (n = 30), mid-term- (1&ndash;3 years) (n = 26), and long-term-recurrence group (&gt;3 years) (n = 11). The short-term-recurrence group was characterized by a higher prevalence of diabetes mellitus (hazard ratio 2.639 (95% confidence interval, 1.174&ndash;5.932), p = 0.019 by the Cox method), frequent AF episodes (&ge;1/week) before ablation (4.038 (1.545&ndash;10.557), p = 0.004), and higher BNP level at baseline (per 10 pg/mL) (1.054 (1.029&ndash;1.081), p &lt; 0.0001). The mid-term-recurrence group was associated with higher BNP level (1.163 (1.070&ndash;1.265), p = 0.0004), larger LAVi (mL/m2) (1.033 (1.007&ndash;1.060), p = 0.013), and longer AF cycle length at baseline (per 10 ms) (1.194 (1.058&ndash;1.348), p = 0.004). In the long-term-recurrence group, the ANP and BNP levels were low throughout follow-up, as with those in the non-recurrence group, and AF cycle length was shorter (0.694 (0.522&ndash;0.924), p = 0.012) than those in the other recurrence groups. Conclusions: Distinct characteristics of AF were found according to the time to first recurrence after PAF ablation. The presence of secondary factors beyond PV reconnections could be considered as mechanisms for the recurrence of PAF in each follow-up period