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Leesar MA, Chen SL. The first reported case of intravascular ultrasound-guided reverse overlapping stenting of a long calcified lesion using ultra-low contrast and metallic roadmaps: case report. Eur Heart J Case Rep 2024; 8:ytad561. [PMID: 38173784 PMCID: PMC10762894 DOI: 10.1093/ehjcr/ytad561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/01/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024]
Abstract
Background Percutaneous coronary intervention (PCI) of a long calcified coronary lesion in patients with chronic kidney disease (CKD) is challenging and can lead to stent under-expansion and contrast-induced acute kidney injury (CI-AKI). We described the first case of intravascular ultrasound (IVUS)-guided reverse overlapping stenting of long calcified left anterior descending (LAD) coronary lesion using ultra-low contrast and the metallic roadmaps to prevent CI-AKI after PCI. Case summary A 77-year-old man with a history of hypertension, type 2 diabetes, and CKD was admitted with angina class 4 and ruled in for non-ST-elevation myocardial infarction. His ejection fraction was 40%. He was referred for cardiac catheterization and PCI. Coronary angiography showed a long calcified stenosis of the LAD. IVUS catheter was advanced at least 10 mm distal to the lesion or stent edge. IVUS images were obtained with automated pullback (1 mm/s) using a commercially available IVUS system with a 60-MHz mechanical transducer (Boston Scientific, Natick, Massachusetts). IVUS showed calcified plaque fractures after balloon angioplasty and intracoronary lithotripsy. The first stent was deployed proximally using the guidewire in the diagonal branch as a metallic roadmap, and the second stent was deployed distally overlapping at the distal edge of the first stent as a roadmap with no contrast injection. Percutaneous coronary intervention was completed successfully using only 12 mL contrast. Glomerular filtration rate remained stable after PCI. Glomerular filtration rate and ejection fraction improved at 12-month follow-up. Discussion We described the first case of the reverse overlapping stenting technique guided by IVUS with no contrast in a patient with CKD and a long calcified LAD lesion. Conventionally, in long lesions, the first stent is deployed distally and the second stent proximally, which requires contrast injection for stent deployment. We demonstrated that the above technique resulted in preventing CI-AKI and improving creatinine as well as ejection fraction at follow-up.
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Affiliation(s)
- Massoud A Leesar
- Division of Cardiology, University of Alabama, 510 20th street South, FOT-920 Birmingham, AL 35294, USA
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing, China
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Chen Z, Mao Q, Xiang L, Zhou D, Jiang Y, Zhao N, Huang L, Azzalini L, Zhao X. Iodixanol-associated acute kidney injury and prognosis in patients undergoing elective percutaneous coronary intervention: a prospective, multi-center study. Eur Radiol 2023; 33:9444-9454. [PMID: 37480548 DOI: 10.1007/s00330-023-09964-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE To evaluate iodixanol-associated acute kidney injury (AKI) and prognosis in patients undergoing elective percutaneous coronary intervention (PCI). METHODS Patients undergoing elective PCI and iodixanol administration were prospectively enrolled in 8 centers between May 2020 and November 2021. The primary endpoint was AKI, defined as an increase in SCr of ≥ 0.3 mg/dL (26.4 μmol/L) or relative elevation ≥ 50% from baseline in the 48-72 h after PCI. Prognosis evaluations included the major adverse renal and cardiovascular events (MARCE): all-cause mortality, new-onset renal replacement therapy (NRRT), non-fatal myocardial infarction, and non-fatal stroke. AKI predictors were identified using multivariable logistic regression and associations between AKI and outcomes were examined using Cox regression. RESULTS A total of 3630 patients were included in the final analysis and 2.9% of patients (107/3,630) suffered AKI. Among them, 95.3% (102/107) of AKI were stage 1, and 4.6% (5/107) of stage 2. The multivariable analysis indicated that age over 75-year-old, diabetes, NT-pro-BNP > 300 pg/mL, hemoglobin < 110 g/L, eGFR < 60 mL/min/1.73m2, and diuretics were independently associated with AKI (p < 0.05). After a median follow-up of 13 months, MARCE occurred in 3.6% (131/3630) of the study population, and their incidence was higher in AKI (9.4%, 10/107) vs. non-AKI patients (3.4%, 121/3,523). However, after multivariable adjustment, there was no statistically significant association between AKI and MARCE (p = 0.382). CONCLUSIONS In patients undergoing elective PCI, cases of iodixanol-associated AKI were mostly mild and, after multivariable adjustment, held no statistically significant association with MARCE on mid-term follow-up. CLINICAL RELEVANCE STATEMENT The incidence of iodixanol-associated AKI was low and mainly limited to mild renal impairment in patients undergoing elective PCI. Physicians should provide adequate contrast for coronary artery evaluation and, at the same time, minimize the contrast volume. KEY POINTS • The incidence of iodixanol-associated acute kidney injury was low and mostly limited to mild renal impairment. • Iodixanol administration had no statistically significant impact on the major adverse renal and cardiovascular events in patients undergoing elective percutaneous coronary intervention.
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Affiliation(s)
- Zaiyan Chen
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Qi Mao
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Li Xiang
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Denglu Zhou
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yanbing Jiang
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ning Zhao
- Department of Cardiovascular Diseases, The General Hospital of Tibet Military Region, Lhasa, China
| | - Lan Huang
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Xiaohui Zhao
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China.
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Zebrauskaite A, Ziubryte G, Mackus L, Lieponyte A, Kairyte E, Unikas R, Jarusevicius G. A Simple Strategy to Reduce Contrast Media Use and Risk of Contrast-Induced Renal Injury during PCI: Introduction of an "Optimal Contrast Volume Protocol" to Daily Clinical Practice. J Cardiovasc Dev Dis 2023; 10:402. [PMID: 37754831 PMCID: PMC10531638 DOI: 10.3390/jcdd10090402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/28/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Contrast-induced acute kidney injury is the leading cause of iatrogenic acute nephropathy. Development of contrast-induced nephropathy (CIN) increases the risk of adverse long- and short-term patients outcomes, the hospital costs, and length of hospitalization. There are a couple of methods described for CIN prevention (statin prescription, prehydration, contrast media (CM) clearance from the blood system, and decrease amounts of contrast volume). The CM volume to patient's creatinine clearance ratio is the main factor to predict the risk of CIN development. The safe CM to creatinine clearance ratio limits have been established. The usage of CM amount depends on personal operators habits and inside center regulations. There is no standardized contrast usage protocol worldwide. The aim of this study was to establish an easy to use, cheap, and efficient protocol to estimate a personalized safe CM dose limit for every patient based on their kidney function. These limits are announced during the "Time Out" before the procedure. Our study included 519 patients undergoing interventional coronary procedures: 207 patients into the "Optimal Contrast Volume" arm and 312 into the control group. Applying the protocol into a daily clinical practice leads to a significant reduction in CM volume used for all type of procedures and the development of CIN in comparison with a control group.
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Affiliation(s)
- Aiste Zebrauskaite
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
- Faculty of Medicine, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Greta Ziubryte
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
| | - Lukas Mackus
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
| | - Austeja Lieponyte
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
| | - Evelina Kairyte
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
| | - Ramunas Unikas
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
- Faculty of Medicine, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Gediminas Jarusevicius
- Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania; (G.Z.); (L.M.); (A.L.); (E.K.); (R.U.); (G.J.)
- Faculty of Medicine, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
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Isaac T, Gilani S, Kleiman NS. When Prevention is Truly Better than Cure: Contrast-Associated Acute Kidney Injury in Percutaneous Coronary Intervention. Methodist Debakey Cardiovasc J 2022; 18:73-85. [PMID: 36132584 PMCID: PMC9461685 DOI: 10.14797/mdcvj.1136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/01/2022] [Indexed: 11/08/2022] Open
Abstract
Contrast-associated acute kidney injury (CA-AKI) is a fairly frequent complication of cardiovascular angiography and percutaneous coronary intervention (PCI). The risk is significantly higher in patients with advanced chronic kidney disease (CKD). Prevention is the only option for avoiding the significant morbidity and mortality associated with CA-AKI. This review provides a concise and clinically directed appraisal of the latest pre-procedural and peri-procedural strategies to minimize the risk of CA-AKI in all patients undergoing PCI. By broadly implementing these evidence-based care bundles, we can dramatically improve outcomes in this vulnerable patient population.
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Affiliation(s)
- Tea Isaac
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Salima Gilani
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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Shrivastava A, Nath RK, Mahapatra HS, Pandit BN, Raj A, Sharma AK, Kumar T, Kuber D, Aggarwal P. Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI). Indian Heart J 2022; 74:363-368. [PMID: 36007555 PMCID: PMC9647695 DOI: 10.1016/j.ihj.2022.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/20/2022] [Accepted: 08/17/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives This prospective, randomized study assessed short-term outcomes and safety of ultra-low contrast percutaneous coronary intervention(ULC-PCI) vs conventional PCI in high risk for contrast induced acute kidney injury(CI-AKI) patients presenting with acute coronary syndrome(ACS). Background Patients at an increased risk of developing CI-AKI can be identified prior to PCI based on their pre-procedural risk scores. ULC-PCI is a novel contrast conservation strategy in such high risk patients for prevention of CI-AKI. Methods 82 patients undergoing PCI for ACS were enrolled having estimated glomerular filtration rate(eGFR) < 60 ml/min/1.73 m2 and moderate to very high pre-procedural risk of developing CI-AKI as calculated by Maioli risk calculator. They were randomized into two groups of 41 patients each of ULC-PCI (contrast volume ≤ patient's eGFR) and conventional PCI (contrast volume ≤ 3xpatient's eGFR). Primary end point was development of CI-AKI. Results Baseline clinical and angiographic characteristics were similar between groups. Primary outcome of CI-AKI occurred more in patients of the conventional PCI group [7 (17.1%)] than in the ULC PCI group [(0 patients), p = 0.012]. Contrast volume (41.02 (±9.8) ml vs 112.54 (±25.18) ml; P < 0.0001) was markedly lower in the ULC-PCI group. No significant difference in secondary safety outcomes between two study arms at 30 days. IVUS was used in 17% patients in ULC PCI. Conclusion ULC-PCI in patients with increased risk of developing CI-AKI is feasible, appears safe, and has the potential to decrease the incidence of CI-AKI specially in resource limited setting such as ours where coronary imaging by IVUS is not possible in every patient.
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Affiliation(s)
| | - Ranjit Kumar Nath
- Department of Cardiology, ABVIMS, Dr R.M.L. Hospital, New Delhi, India
| | | | | | - Ajay Raj
- Department of Cardiology, ABVIMS, Dr R.M.L. Hospital, New Delhi, India
| | - Ajay Kumar Sharma
- Department of Cardiology, ABVIMS, Dr R.M.L. Hospital, New Delhi, India
| | - Tarun Kumar
- Department of Cardiology, ABVIMS, Dr R.M.L. Hospital, New Delhi, India
| | - Dheerendra Kuber
- Department of Cardiology, ABVIMS, Dr R.M.L. Hospital, New Delhi, India
| | - Puneet Aggarwal
- Department of Cardiology, ABVIMS, Dr R.M.L. Hospital, New Delhi, India
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Abstract
In this digital era, artificial intelligence (AI) is establishing a strong foothold in commercial industry and the field of technology. These effects are trickling into the healthcare industry, especially in the clinical arena of cardiology. Machine learning (ML) algorithms are making substantial progress in various subspecialties of cardiology. This will have a positive impact on patient care and move the field towards precision medicine. In this review article, we explore the progress of ML in cardiovascular imaging, electrophysiology, heart failure, and interventional cardiology.
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Beneduce A, Russo F, Ancona MB, Ferri LA, Bellini B, Vella C, Di Maio S, Carlino M, Chieffo A, Montorfano M. Real-Time Intravascular Ultrasound Guidance for Ultra-Low Contrast Complex Bifurcation Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2022; 15:e151-e154. [PMID: 35643762 DOI: 10.1016/j.jcin.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Alessandro Beneduce
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
| | - Filippo Russo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Bruno Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Angelo Ferri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Ciro Vella
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvana Di Maio
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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Jovin IS, Warsavage TJ, Plomondon ME, Grunwald GK, Waldo SW, Rao SV, Brilakis ES, Azzalini L. Iso-osmolar versus low-osmolar contrast media and outcomes after percutaneous coronary intervention: Insights from the VA CART Program. Catheter Cardiovasc Interv 2022; 100:85-93. [PMID: 35500170 DOI: 10.1002/ccd.30218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/12/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To assess whether contrast media type is associated with outcomes in veterans undergoing percutaneous coronary intervention (PCI). BACKGROUND There is uncertainty about the impact of iso-osmolar contrast medium (IOCM) versus low-osmolar contrast medium (LOCM) on acute kidney injury (AKI) and other major adverse renal or cardiovascular events (MARCE) after PCI. We assessed the association between contrast media type and MARCE in patients who underwent PCI within the Veterans Administration Healthcare System. METHODS We reviewed PCIs performed between 2009 and 2019 using data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. The primary endpoint was MARCE, a composite of myocardial infarction, stroke, all-cause death, AKI, and dialysis onset at 30 days. RESULTS The analysis cohort consisted of 50,389 patients of whom 25,555 received LOCM and 24,834 received IOCM. There was significant variation in contrast type across sites. After adjustment for comorbidities, no significant association between contrast media type and MARCE was observed in both site-unadjusted (odds ratio [OR] for IOCM: 0.99; 95% confidence interval [CI]: 0.92-1.08; p = 0.97) and site-adjusted (OR: 1.06; 95% CI: 0.95-1.18; p = 0.30) analyses. Similar results were obtained when contrast volume was imputed or the data was subset to individuals with available contrast volume. CONCLUSION In a large cohort of veterans undergoing PCI, we found considerable site variation in the type of contrast media used but no significant association between contrast media type and the incidence of MARCE, both before and after adjustment for the site.
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Affiliation(s)
- Ion S Jovin
- Department of Medicine, McGuire VAMC, Richmond, Virginia, USA.,Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Mary E Plomondon
- VA CART Program, VHA Office of Quality and Safety, Washington, District of Columbia, USA
| | - Gary K Grunwald
- Department of Biostatistics, University of Colorado, Aurora, Colorado, USA
| | - Stephen W Waldo
- VA CART Program, VHA Office of Quality and Safety, Washington, District of Columbia, USA.,Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sunil V Rao
- The Durham VA Health System, Durham, North Carolina, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Lorenzo Azzalini
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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van der Molen AJ, Dekkers IA, Bedioune I, Darmon-Kern E. A systematic review of the incidence of hypersensitivity reactions and post-contrast acute kidney injury after ioversol: part 2-intra-arterial administration. Eur Radiol 2022; 32:5546-5558. [PMID: 35312791 PMCID: PMC9279267 DOI: 10.1007/s00330-022-08637-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/03/2021] [Accepted: 01/03/2022] [Indexed: 11/21/2022]
Abstract
Objectives To evaluate the incidence of adverse drug reactions (ADRs), including hypersensitivity reactions (HSRs) and post-contrast acute kidney injury (PC-AKI), after intra-arterial (IA) administration of ioversol. Methods and materials A systematic literature search was performed (1980–2021) and studies documenting IA use of ioversol, and reporting safety outcomes were selected. Key information on study design, patients’ characteristics, indication, dose, and type of safety outcome were extracted. Results Twenty-eight studies (including two pediatric studies) with 8373 patients exposed to IA ioversol were selected. Studies were highly heterogenous in terms of design, PC-AKI definition, and studied population. PC-AKI incidence after coronary angiography was 7.5–21.9% in a general population, 4.0-26.4% in diabetic patients, and 5.5–28.9% in patients with chronic kidney disease (CKD). PC-AKI requiring dialysis was rare and reported mainly in patients with severe CKD. No significant differences in PC-AKI rates were shown in studies comparing different iodinated contrast media (ICM). Based on seven studies of ioversol clinical development, the overall ADR incidence was 1.6%, comparable to that reported with other non-ionic ICM. Pediatric data were scarce with only one study reporting on PC-AKI incidence (12%), and one reporting on ADR incidence (0.09%), both after coronary angiography. Conclusions After ioversol IA administration, PC-AKI incidence was highly variable between studies, likely reflecting the heterogeneity of the included study populations, and appeared comparable to that reported with other ICM. The rate of other ADRs appears to be low. Well-designed studies are needed for a better comparison with other ICM. Key Points • PC-AKI incidence after IA administration of ioversol appears to be comparable to that of other ICM, despite the high variability between studies. • The need for dialysis after IA administration of ioversol is rare. • No obvious difference was found regarding the safety profile of ioversol between IA and IV administration.
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Affiliation(s)
- Aart J van der Molen
- Contrast Media Safety Research Group, Department of Radiology C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333, ZA, Leiden, The Netherlands.
| | - Ilona A Dekkers
- Contrast Media Safety Research Group, Department of Radiology C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333, ZA, Leiden, The Netherlands
| | - Ibrahim Bedioune
- Clinical Development Department, Guerbet, Roissy CDG Cedex, France
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Seetharam K, Shrestha S, Sengupta PP. Cardiovascular Imaging and Intervention Through the Lens of Artificial Intelligence. Interv Cardiol 2021; 16:e31. [PMID: 34754333 PMCID: PMC8559149 DOI: 10.15420/icr.2020.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/18/2021] [Indexed: 12/13/2022] Open
Abstract
Artificial Intelligence (AI) is the simulation of human intelligence in machines so they can perform various actions and execute decision-making. Machine learning (ML), a branch of AI, can analyse information from data and discover novel patterns. AI and ML are rapidly gaining prominence in healthcare as data become increasingly complex. These algorithms can enhance the role of cardiovascular imaging by automating many tasks or calculations, find new patterns or phenotypes in data and provide alternative diagnoses. In interventional cardiology, AI can assist in intraprocedural guidance, intravascular imaging and provide additional information to the operator. AI is slowly expanding its boundaries into interventional cardiology and can fundamentally alter the field. In this review, the authors discuss how AI can enhance the role of cardiovascular imaging and imaging in interventional cardiology.
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Affiliation(s)
- Karthik Seetharam
- West Virginia University Medicine Heart and Vascular Institute Morgantown, WV, US
| | - Sirish Shrestha
- West Virginia University Medicine Heart and Vascular Institute Morgantown, WV, US
| | - Partho P Sengupta
- West Virginia University Medicine Heart and Vascular Institute Morgantown, WV, US
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Biccirè FG, Budassi S, Prati F. The DyeVert System Choice in OCT Guidance of PCI: Is the Game Worth the Candle? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 30:47-49. [PMID: 34219030 DOI: 10.1016/j.carrev.2021.06.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Flavio Giuseppe Biccirè
- Sapienza University of Rome, Rome, Italy; Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Simone Budassi
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Francesco Prati
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy; UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy.
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12
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Werner GS, Lorenz S, Yaginuma K, Koch M, Tischer K, Werner J, Keuser T, Moehlis H, Riegel W. A prospective study on the incidence of contrast-associated acute kidney injury after recanalization of chronic total coronary occlusions with contemporary interventional techniques. Int J Cardiol 2021; 337:38-43. [PMID: 34015410 DOI: 10.1016/j.ijcard.2021.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Contrast-associated acute kidney injury (CA-AKI) is a potential risk associated with the percutaneous coronary interventions (PCI) for chronic total coronary occlusions (CTO). This study should evaluate the incidence of CA-AKI in an era of advanced strategies of recanalization techniques and identify modifiable determinants. METHODS We analysed 1924 consecutive CTO procedures in 1815 patients between 2012 and 2019. All patients were carefully monitored at least up to 48 h after a CTO procedure for changes in renal function. RESULTS The incidence of CA-AKI was 5.6%, but there was no relation to the technical approach such as frequency of the retrograde technique, intravascular ultrasound or radial access. Procedures with CA-AKI had longer fluoroscopy times (37.6 vs 46.1 min; p = 0.005). The major determinants of CA-AKI were age, presence of diabetes and reduced ejection fraction, as well as chronic kidney disease stage ≥2, serum haemoglobin, and fluoroscopy time. Contrast volume or contrast volume/GFR ratio were not independent determinants of CA-AKI. Periprocedural perforations were more frequent in CA-AKI patients (11.3 vs 2.3%; p < 0.001), and in-hospital mortality was higher (2.8 vs 0.4%; p < 0.001). CONCLUSIONS CA-AKI was associated with the risk of in-hospital adverse events. Established patient-related risk factors for CA-AKI (age, diabetes, preexisting chronic kidney disease, low ejection fraction) were confirmed in this study. In addition, the length of the procedure, coronary perforations and low preprocedural serum haemoglobin were risk factors that might be preventable in patients at high risk for CA-AKI.
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Affiliation(s)
- Gerald S Werner
- Medizinische Klinik 1, Klinikum Darmstadt GmbH, Darmstadt, Germany.
| | - Simon Lorenz
- Medizinische Klinik 3, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Kenji Yaginuma
- Department of Cardiology, Juntendo University Urayasu Hospital, Tokyo, Japan
| | - Mathias Koch
- Medizinische Klinik 1, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | | | - Juliane Werner
- Medizinische Klinik 1, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Thomas Keuser
- Medizinische Klinik 1, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Hiller Moehlis
- Medizinische Klinik 1, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Werner Riegel
- Medizinische Klinik 3, Klinikum Darmstadt GmbH, Darmstadt, Germany
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13
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Zdziechowska M, Gluba-Brzózka A, Franczyk B, Rysz J. Biochemical Markers in the Prediction of Contrast-induced Acute Kidney Injury. Curr Med Chem 2021; 28:1234-1250. [PMID: 32357810 DOI: 10.2174/0929867327666200502015749] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 03/21/2020] [Accepted: 03/29/2020] [Indexed: 11/22/2022]
Abstract
For many years clinicians have been searching for "kidney troponin"- a simple diagnostic tool to assess the risk of acute kidney injury (AKI). Recently, the rise in the variety of contrast-related procedures (contrast computed tomography (CT), percutaneous coronary intervention (PCI) and angiography) has resulted in the increased number of contrast-induced acute kidney injuries (CI-AKI). CIAKI remains an important cause of overall mortality, prolonged hospitalisation and it increases the total costs of therapy. The consequences of kidney dysfunction affect the quality of life and they may lead to disability as well. Despite extensive worldwide research, there are no sensitive and reliable methods of CI-AKI prediction. Kidney Injury Molecule 1 (KIM-1) and Neutrophil Gelatinase Lipocalin (NGAL) have been considered as kidney-specific molecules. High concentrations of these substances before the implementation of contrast-related procedures have been suggested to enable the estimation of kidney vulnerability to CI-AKI and they seem to have the predictive potential for cardiovascular events and overall mortality. According to other authors, routine determination of known inflammation factors (e.g., CRP, WBC, and neutrophil count) may be helpful in the prediction of CIAKI. However, the results of clinical trials provide contrasting results. The pathomechanism of contrast- induced nephropathy remains unclear. Due to its prevalence, the evaluation of the risk of acute kidney injury remains a serious problem to be solved. This paper reviews pathophysiology and suggested optimal markers facilitating the prediction of contrast-induced acute kidney injury.
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Affiliation(s)
- Magdalena Zdziechowska
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
| | - Anna Gluba-Brzózka
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
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14
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Zhao N, Chen Z, Zhou Y, Xu Q, Xu Z, Tong W, Li L, Mao Q, Song Y, Jin J, Huang L, Azzalini L, Zhao X. Effects of a High Dose of the Contrast Medium Iodixanol on Renal Function in Patients Following Percutaneous Coronary Intervention. Angiology 2020; 72:145-152. [PMID: 32911955 DOI: 10.1177/0003319720953044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Iodixanol is associated with lower rates of contrast-induced acute kidney injury (CI-AKI). However, the effects of high volumes of iodixanol on renal function after percutaneous coronary intervention (PCI) have not been fully elucidated. This study evaluates the effects of high-dose (>300 mL) iodixanol on renal function within 72 hours of PCI. We retrospectively reviewed 676 consecutive patients who received high-dose (>300 mL) iodixanol during PCI between October 2015 and December 2017 in 4 centers. Logistic regression analysis was used to identify significant independent predictors for CI-AKI. The incidence of CI-AKI was 3.5% (23/651). In patients administered 300 to 500 mL and >500 mL iodixanol, the incidence of CI-AKI was 3.9% and 1.7%, respectively. In patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, the incidence of CI-AKI was 2.6%. In high-risk and very high-risk patients, stratified by the Mehran risk score, the incidence of CI-AKI was 3.3% and 4.3%, respectively. In patients received high-dose iodixanol (>300 mL), logistic regression analysis demonstrated that female sex, chronic kidney disease, and eGFR were independent risk factors for CI-AKI, but contrast volume was not. The administration of high (300-500 mL) and very high (>500 mL) dose of iodixanol is associated with low rates of CI-AKI.
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Affiliation(s)
- Ning Zhao
- Institution of Cardiovascular Research, Xinqiao Hospital, 105785Third Military Medical University (Army Medical University), Chongqing, China
| | - Zaiyan Chen
- Institution of Cardiovascular Research, Xinqiao Hospital, 105785Third Military Medical University (Army Medical University), Chongqing, China
| | - Yinpin Zhou
- The Fuling Central Hospital of Chongqing, Chongqing, China
| | - Qiang Xu
- The Fifth people's Hospital of Chongqing, Chongqing, China
| | - Zhonglin Xu
- The Ninth people's Hospital of Chongqing, Chongqing, China
| | - Wuyang Tong
- Institution of Cardiovascular Research, Xinqiao Hospital, 105785Third Military Medical University (Army Medical University), Chongqing, China
| | - Lufeng Li
- Institution of Cardiovascular Research, Xinqiao Hospital, 105785Third Military Medical University (Army Medical University), Chongqing, China
| | - Qi Mao
- Institution of Cardiovascular Research, Xinqiao Hospital, 105785Third Military Medical University (Army Medical University), Chongqing, China
| | - Yaoming Song
- Institution of Cardiovascular Research, Xinqiao Hospital, 105785Third Military Medical University (Army Medical University), Chongqing, China
| | - Jun Jin
- Institution of Cardiovascular Research, Xinqiao Hospital, 105785Third Military Medical University (Army Medical University), Chongqing, China
| | - Lan Huang
- Institution of Cardiovascular Research, Xinqiao Hospital, 105785Third Military Medical University (Army Medical University), Chongqing, China
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, 6889Virginia Commonwealth University, Richmond, VA, USA
| | - Xiaohui Zhao
- Institution of Cardiovascular Research, Xinqiao Hospital, 105785Third Military Medical University (Army Medical University), Chongqing, China
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15
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Zhang F, Lu Z, Wang F. Advances in the pathogenesis and prevention of contrast-induced nephropathy. Life Sci 2020; 259:118379. [PMID: 32890604 DOI: 10.1016/j.lfs.2020.118379] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/18/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022]
Abstract
With the increasing application of medical imaging contrast materials, contrast-induced nephropathy has become one of the leading causes of iatrogenic renal insufficiency. The underlying mechanism is associated with renal medullary hypoxia, direct toxicity of contrast agents, oxidative stress, apoptosis, immune/inflammation and epigenetic regulation in contrast-induced nephropathy. Up to date, there is no effective therapy for contrast-induced nephropathy, and thus risk predication and effective preventive strategies are keys to reduce the occurrence of contrast-induced nephropathy. It was found that the proper use of contrast medium, personalized hydration, and high-dose statins may reduce the occurrence of contrast-induced nephropathy, while antioxidants have not shown significant therapeutic benefits. Additionally, the role of remote ischemia preconditioning and vasodilators in the prevention of contrast-induced nephropathy needs further study. This review aims to discuss the incidence, pathogenesis, risk prediction, and preventive strategies for contrast-induced nephropathy.
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Affiliation(s)
- Fangfei Zhang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Zeyuan Lu
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Feng Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
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16
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Sardar P, Abbott JD, Kundu A, Aronow HD, Granada JF, Giri J. Impact of Artificial Intelligence on Interventional Cardiology: From Decision-Making Aid to Advanced Interventional Procedure Assistance. JACC Cardiovasc Interv 2020; 12:1293-1303. [PMID: 31320024 DOI: 10.1016/j.jcin.2019.04.048] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 02/26/2019] [Accepted: 04/02/2019] [Indexed: 11/26/2022]
Abstract
Access to big data analyzed by supercomputers using advanced mathematical algorithms (i.e., deep machine learning) has allowed for enhancement of cognitive output (i.e., visual imaging interpretation) to previously unseen levels and promises to fundamentally change the practice of medicine. This field, known as "artificial intelligence" (AI), is making significant progress in areas such as automated clinical decision making, medical imaging analysis, and interventional procedures, and has the potential to dramatically influence the practice of interventional cardiology. The unique nature of interventional cardiology makes it an ideal target for the development of AI-based technologies designed to improve real-time clinical decision making, streamline workflow in the catheterization laboratory, and standardize catheter-based procedures through advanced robotics. This review provides an introduction to AI by highlighting its scope, potential applications, and limitations in interventional cardiology.
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Affiliation(s)
- Partha Sardar
- Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - J Dawn Abbott
- Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Amartya Kundu
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Herbert D Aronow
- Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Juan F Granada
- Cardiovascular Research Foundation, Columbia University Medical Center, New York, New York
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, Pennsylvania.
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17
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Fu JJ, Guo JJ, Qin AP, Yu XY, Zhang Q, Lei XP, Huang YG, Chen MY, Li JX, Zhang Y, Liu JP, Dang YY, Wu D, Zhao XY, Lin ZX, Lin YL, Li SP, Zhang LY. Bismuth chelate as a contrast agent for X-ray computed tomography. J Nanobiotechnology 2020; 18:110. [PMID: 32762751 PMCID: PMC7412782 DOI: 10.1186/s12951-020-00669-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/30/2020] [Indexed: 01/12/2023] Open
Abstract
Backgrounds Due to the unexpected side effects of the iodinated contrast agents, novel contrast agents for X-ray computed tomography (CT) imaging are urgently needed. Nanoparticles made by heavy metal elements are often employed, such as gold and bismuth. These nanoparticles have the advantages of long in vivo circulation time and tumor targeted ability. However, due to the long residence time in vivo, these nanoparticles may bring unexpected toxicity and, the preparation methods of these nanoparticles are complicated and time—consuming. Methods In this investigation, a small molecular bismuth chelate using diethylenetriaminepentaacetic acid (DPTA) as the chelating agent was proposed to be an ideal CT contrast agent. Results The preparation method is easy and cost—effective. Moreover, the bismuth agent show better CT imaging for kidney than iohexol in the aspect of improved CT values. Up to 500 µM, the bismuth agent show negligible toxicity to L02 cells and negligible hemolysis. And, the bismuth agent did not induce detectable morphology changes to the main organs of the mice after intravenously repeated administration at a high dose of 250 mg/kg. The pharmacokinetics of the bismuth agent follows the first—order elimination kinetics and, it has a short half—life time of 0.602 h. The rapid clearance from the body promised its excellent biocompatibility. Conclusions This bismuth agent may serve as a potential candidate for developing novel contrast agent for CT imaging in clinical applications.
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Affiliation(s)
- Ji-Jun Fu
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China. .,School of Materials Science and Energy Engineering, Foshan University, Foshan, 528000, China.
| | - Jun-Jie Guo
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ai-Ping Qin
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Xi-Yong Yu
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Qiang Zhang
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Xue-Ping Lei
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Yu-Gang Huang
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Ming-Yue Chen
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Jie-Xia Li
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Yu Zhang
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Jing-Ping Liu
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yuan-Ye Dang
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Dan Wu
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Xiao-Ya Zhao
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Zhong-Xiao Lin
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Yin-Lei Lin
- School of Materials Science and Energy Engineering, Foshan University, Foshan, 528000, China
| | - Song-Pei Li
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China.
| | - Ling-Yan Zhang
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.
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18
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Azzalini L, Kalra S. Contrast-Induced Acute Kidney Injury-Definitions, Epidemiology, and Implications. Interv Cardiol Clin 2020; 9:299-309. [PMID: 32471671 DOI: 10.1016/j.iccl.2020.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is the acute onset of renal injury following exposure to iodinated contrast media. Several definitions have been used, which complicates the estimation of the epidemiological relevance of this condition and comparisons in outcome research. The incidence of CI-AKI increases as a function of patient and procedure complexity in coronary, endovascular, and structural interventions. CI-AKI is associated with a high burden of short- and long-term adverse events, and leads to increased healthcare costs. This review will provide an overview of the definitions, epidemiology, and implications of CI-AKI in patients undergoing coronary, endovascular, and structural catheter-based procedures.
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Affiliation(s)
- Lorenzo Azzalini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, Klingenstein Clinical Center, 7th Floor North, 1450 Madison Avenue, New York, NY 10029, USA.
| | - Sanjog Kalra
- Einstein Heart and Vascular Institute, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA 19085, USA
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19
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Sun XP, Fan Z, Liu Z, Li J, Hua Q. Serum Osmolarity and Contrast-Induced Nephropathy. Angiology 2020; 71:475-476. [PMID: 31167543 DOI: 10.1177/0003319719853986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Xi-Peng Sun
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenxing Fan
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhi Liu
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Hua
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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20
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Demir OM, Poletti E, Lombardo F, Laricchia A, Beneduce A, Maccagni D, Cappelletti A, Colombo A, Bellini B, Ancona MB, Carlino M, Chieffo A, Montorfano M, Azzalini L. Rotational atherectomy-based percutaneous coronary intervention and the risk of contrast-induced nephropathy. Minerva Cardioangiol 2020; 68:137-145. [PMID: 32100984 DOI: 10.23736/s0026-4725.20.05099-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Rotational atherectomy (RA)-related complications (e.g., no-reflow and perforation) may be associated with increased risk of contrast-induced nephropathy (CIN), causing hypotension, acute heart failure, and periprocedural myocardial infarction. Our aim was to evaluate the incidence of CIN in patients undergoing RA-based vs. non-RA-based percutaneous coronary intervention (PCI). METHODS This single-center retrospective registry included all patients who underwent PCI between 2012 and 2016 for whom post-procedural creatinine was determined. Study endpoint was CIN, defined as an increase of serum creatinine ≥0.3 mg/dL or ≥50% from baseline within 72 h post-PCI. Propensity score matching (PSM) was performed to account for selection bias between RA and non-RA patients. RESULTS Study population included 2580 patients: 70 (3%) had RA PCI and 2510 (97%) had non-RA PCI. Following PSM, there were 70 patients in RA and 280 patients in non-RA group with good overall adjustment between groups, although RA patients received larger contrast volume (263±126 vs. 224±118 mL, P=0.01) and showed higher Mehran risk score at baseline (11.1±6.6 vs. 8.9±4.8, P=0.01). The incidence of CIN was similar between RA and non-RA patients (15.7% vs. 13.2%, P=0.59). New need for dialysis was required in 0% vs. 0.7% patients, respectively (P=0.48). On multivariate analysis, RA PCI was not independently associated with development of CIN. CONCLUSIONS Despite being performed in patients with a higher burden of comorbidities and with larger volumes of contrast, RA PCI is not associated with higher risk of CIN, compared with PCI in non-RA patients.
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Affiliation(s)
- Ozan M Demir
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Enrico Poletti
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Lombardo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Laricchia
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Maccagni
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Cappelletti
- Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy -
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21
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Du M, Jiang L, Tang X, Gao Z, Xu B, Yuan J. Contrast Induced Nephropathy and 2-Year Outcomes of Iso-Osmolar Compared with Low-Osmolar Contrast Media after Elective Percutaneous Coronary Intervention. Korean Circ J 2020; 51:174-181. [PMID: 33525073 PMCID: PMC7853897 DOI: 10.4070/kcj.2020.0307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/25/2020] [Accepted: 11/03/2020] [Indexed: 12/29/2022] Open
Abstract
Background and Objectives This study investigated the relative incidence of contrast induced nephropathy (CIN) and long-term outcomes between iso-osmolar contrast media (IOCM) and low-osmolar contrast media (LOCM) undergoing elective percutaneous coronary intervention (PCI). Methods A total of 9,431 patients receiving elective PCI were enrolled in the cohort. The patients were divided into IOCM group and LOCM group. Propensity score matching (PSM) was applied to minimize the selection bias between groups. Results The multivariate analysis showed that the use of IOCM compared with LOCM did not affect the CIN incidence (odds ratio [OR], 0.912; 95% confidence interval [CI], 0.576–1.446; p=0.696). After PSM, the incidence of CIN was 1.5% and 4.0% in IOCM group (n=979) and LOCM group (n=979), respectively, p=0.001. IOCM significantly reduced the incidence of CIN compared with LOCM (OR, 0.393; 95% CI, 0.214–0.722; p=0.003). After 2 years of follow-up, the all-cause mortality was higher in IOCM group than LOCM group (2.1% vs. 0.9%, p<0.001). Cox regression analysis showed IOCM was not independent risk factor of 2-years all-cause mortality (OR, 0.849; 95% CI, 0.510–1.412; p=0.528). After PSM, the difference of all-cause death between groups disappeared (1.7% vs. 1.9%, p=0.739). Cox regression analysis showed that the use of IOCM compared with LOCM did not affect the incidence of 2-year all-cause mortality (OR, 1.037; 95% CI, 0.534–2.014; p=0.915). Conclusions Compared with LOCM, IOCM significantly reduced the incidence of CIN after elective PCI, but had no significant effect on 2-year all-cause mortality.
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Affiliation(s)
- Mengyang Du
- Department of Cardiology, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Jiang
- Department of Cardiology, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofang Tang
- Department of Cardiology, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhan Gao
- Department of Cardiology, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Cardiology, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jinqing Yuan
- Department of Cardiology, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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22
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Procedural Strategies to Reduce the Incidence of Contrast-Induced Acute Kidney Injury During Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:1877-1888. [DOI: 10.1016/j.jcin.2019.04.055] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 11/23/2022]
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23
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Risk of contrast-induced nephropathy in patients undergoing complex percutaneous coronary intervention. Int J Cardiol 2019; 290:59-63. [DOI: 10.1016/j.ijcard.2019.04.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/07/2019] [Accepted: 04/12/2019] [Indexed: 01/06/2023]
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24
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Paraskevas KI, Geroulakos G, Vlahakos DV. Contrast-Induced Nephropathy after Endovascular Aneurysm Repair, Carotid and Peripheral Interventions. Curr Vasc Pharmacol 2019; 18:531-532. [PMID: 31455200 DOI: 10.2174/1570161117999190821145924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of Vascular Surgery, 'Attikon' University Hospital, Athens, Greece
| | - George Geroulakos
- Department of Vascular Surgery, 'Attikon' University Hospital, Athens, Greece
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25
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Abstract
Contrast nephropathy (CN) is acute kidney injury (AKI) that occurs within 24 to 72 hours of iodinated contrast medium (ICM) administration. Mechanisms of CN include hyperviscosity, free radical formation, and renal medullary oxygen supply/demand mismatch. Although risk factors for CN have been identified, it remains uncertain whether ICM causes or is simply associated with AKI. The cornerstones of CN prevention are using low-osmolal ICM, intravenous hydration, and statins, especially in patients with chronic kidney disease. With appropriate CN risk mitigation, coronary angiography and intervention should not be routinely withheld from patients with acute coronary syndromes.
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Affiliation(s)
- James E Novak
- Division of Nephrology, Henry Ford Hospital, Wayne State University, CFP-505, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
| | - Richa Handa
- Division of Nephrology, Henry Ford Hospital, CFP-506, 2799 West Grand Boulevard, Detroit, MI 48202, USA
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26
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Zhao F, Lei R, Yang SK, Luo M, Cheng W, Xiao YQ, Li XW, Guo J, Duan SB. Comparative effect of iso-osmolar versus low-osmolar contrast media on the incidence of contrast-induced acute kidney injury in diabetic patients: a systematic review and meta-analysis. Cancer Imaging 2019; 19:38. [PMID: 31215488 PMCID: PMC6580528 DOI: 10.1186/s40644-019-0224-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 06/04/2019] [Indexed: 01/19/2023] Open
Abstract
Background Contrast-induced acute kidney injury (CI-AKI) is a major adverse effect caused by intravascular administration of iodinated contrast medium. Whether there is a difference in CI-AKI incidence between iso-osmolar (IOCM) and low-osmolar contrast media (LOCM) among diabetic patients is controversial. Methods Randomized controlled trials comparing the nephrotoxic effects between IOCM and LOCM in diabetic patients with or without CKD (eGFR< 60 ml/min/1.73 m2) were included in the analysis. The incidence of CI-AKI was defined as an initial increase in serum creatinine (SCr) concentration of at least 0.5 mg/dl or a rise in creatinine of 25% from baseline. Results A total of 2190 patients were included, among whom 1122 patients received IOCM and 1068 received LOCM. When compared to LOCM, IOCM had no significant benefit in preventing CI-AKI (OR = 1.66, [CI: 0.97–2.84], P = 0.06, I2 = 54%). However, the difference between IOCM and LOCM was found when CI-AKI was defined as an absolute SCr increase (≥0.5 mg/dl) rather than a relative SCr increase (≥25%). Further analysis showed that LOCM resulted in more adverse events. Conclusions Whether there is a difference of CI-AKI incidence between IOCM and LOCM in diabetic patients was related to the selected diagnostic criteria. The incidence of adverse events was significantly lower with IOCM when compared with LOCM. Therefore, we suggest that IOCM may be used in diabetic and CKD (eGFR< 60 ml/min/1.73 m2) patients. Electronic supplementary material The online version of this article (10.1186/s40644-019-0224-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fei Zhao
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Rong Lei
- Department of Nephrology, Changsha Central hospital, Changsha, 410004, Hunan, People's Republic of China
| | - Shi-Kun Yang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, People's Republic of China
| | - Min Luo
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Wei Cheng
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Ye-Qing Xiao
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Xu-Wei Li
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Jun Guo
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Shao-Bin Duan
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
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27
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Low incidence of nephrotoxicity following intravenous administration of iodinated contrast media: a prospective study. Eur Radiol 2019; 29:3927-3934. [DOI: 10.1007/s00330-019-06147-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/13/2019] [Accepted: 03/08/2019] [Indexed: 12/20/2022]
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28
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Kronbichler A, Shin JI, Windpessl M. What is left to prevent contrast-induced acute kidney injury? No difference between low and iso-osmolar contrast media. Int J Cardiol 2018; 273:94-95. [PMID: 30236501 DOI: 10.1016/j.ijcard.2018.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria.
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Pediatric Nephrology, Severance Children's Hospital, Seoul, Republic of Korea; Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Martin Windpessl
- Department of Internal Medicine IV, Section of Nephrology, Klinikum Wels-Grieskirchen, Wels, Austria
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