Professional Documents
Culture Documents
Annis Rakhmawati
Identitas Jurnal
Judul : Role of Hydration in ContrastInduced Nephropathy in Patients Who
Underwent Primary Percutaneous
Coronary Intervention
Penulis : Alfonso Jurado-Romn et al
Publikasi
:
Am
2015;115:1174-1178
Cardiol
INTRODUCTION
The incidence of CIN in Primary PCI (PPCI) for
STEMI patient is higher than in elective
procedures.
There is no preventive strategy has been
recommended by current guidelines for
STEMI who underwent PPCI
The aim to evaluate the possible beneficial
role of periprocedural i.v isotonic saline
in STEMI patient who underwent PPCI
Subjects
Inclusion Criteria
All STEMI patients who underwent PPCI
July 2012 to November 2013 at their
institution (Cardiology Department, Madrid,
Spain)
Exclusion Criteria:
end-stage renal failure requiring dialysis
cardiac arrest
severe heart failure (Killip III to IV)
Methods
Prospective, single-center, randomized study
to investigate the role of hydration to
prevent CIN in STEMI patient who underwent
PPCI.
All patients received an iso-osmolar nonionic
contrast medium (iodixanol).
Primary end point the development of CIN
25% or 0.5 mg/dl increase in serum
creatinine within 3 days post procedural.
Baseline Characteristics
Procedural Characteristics
RESULT
Discussion
In STEMI with elective PCI, i.v hydration
is simple & effective to prevent CIN.
Not only patients with CKD have CIN
variety of other risk factors facilitate CIN
in patients with normal renal function
Current guidelines havent still
suggested definite recommendations
about CIN prevention in PPCI
Thayssen et al
Prevention with NAC, NaHCO3, or the
combined NAC+NaHCO3 didnt
reduce the rate of CIN significantly
compared with hydration with i.v
NaCl infusion alone
Study limitation
Single-center study without blinding
& small sample size
The significant crossover rate
between both treatment groups
expected limitation an intentionto-treat analysis was performed
Conclusion
i.v saline hydration during PPCI
reduced the risk of CIN to 48%.
Patients with CIN had increased
mortality and need for dialysis.
Preventive hydration should be given
to STEMI patients underwent PPCI.
Critical Appraisal
Are the results Valid
1. Was the assignment of patients to treatments randomized? And
was the randomization list concealed? yes
2. Was follow-up of patients sufficiently long and complete? yes
3. Were patients analyzed in the groups which they were randomized?
yes
4. Were patients and clinicians kept blind to treatment? no
5. Were the groups treated equally, apart from the experimental
treatment? yes
6. Were the groups similar at the start of the trial? yes
Thank you