CLINICAL AUDIT , Apollo

Hospital,Heath City
TOPIC : Incidence of Contrast Induced Nephropathy in patients undergoing PCI.

Presenter: Dr Rajesh P ( DNB Resident, Department of Cardiology)

Guides: Dr N K Panigrahi ( Sr Consultant Cardiologist HOD - Department of Cardiology)
Dr D K Baruah (Sr Consultant Cardiologist, Director of Cath Lab)
OBJECTIVES

This study sought to determine the incidence of CA- AKI in patients undergoing Percutaneous
Coronary Interventions and compare with the average incidence and
to identify subsets of patients at increased risk of developing CA- AKI
Background

Definition: CA-AKI was defined as a post-PCI increase in serum creatinine of >0.5 mg/dL
or a relative increase of > 25% compared with pre-PCI

• Large Consensus that it is benign, transient creatinine “bumps”. The rate of AKI was 6.5%, and most of
these were small “bumps” in creatinine, with the median change in creatinine of only 0.3 mg/dL

• 20% of patients with baseline CKD who develop CA-AKI have persistent renal
dysfunction. (Maioli et al)

• Persistent renal dysfunction was associated with higher mortality at 5 years compared with
those without or with transient CA - AKI

• 2-fold increase in 6-month mortality for patients with CA-AKI defined as an absolute increase over
baseline creatinine >0.3 mg/dL, but not for patients with lesser degrees of CA-AKI (creatinine >25%
over baseline, but not exceeding 0.5 mg/dL absolute increase (Guillon et al)
 ADAPT-DES trial (Assessment of Dual Antiplatelet Therapy With Drug Eluting Stents), in
various subsets of patient with or without pre-existing chronic kidney disease (CKD)

• CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2

• The primary endpoint was the 2-year rate of net adverse clinical events (NACE): All-cause mortality,
myocardial infarction (MI), definite or probable stent thrombosis, or major bleeding.

• 7287 (85%) patients with evaluable data, 476 (6.5%) developed CA-AKI

• At 2 years, CA-AKI was associated with a 2-fold increase in cardiac death and an
increased risk of MI, stent thrombosis

• Older age, female sex, congestive heart failure, diabetes, hypertension, CKD, presentation with ST-
segmentelevation MI, Killip class II to IV, radial access, intra-aortic balloon pump use, hypotension,
and number of stents were independent predictors of CA-AKI.
The study clearly demonstrates higher rates of adverse events, including death, even with small
“bumps” in creatinine

• CA-AKI (persistent or Transient) or is a marker of patients at increased risk.

• A large study found a <2% rate of CA-AKI and <0.1% rate of need for dialysis if the contrast
dose to calculated creatine clearance ratio was <2. Ideally, can achieve a ratio of <1 with the
miserly use of contrast

• The 2 methods that consistently reduce risk of CA-AKI are hydration and limiting
contrast volume.
Aim of the study

This study sought to determine

• The incidence of CA – AKI in 200 Patients undergoing one or more than one DES

• Identifying High Risk Subsets likely to develop CA-AKI and further help guide pre procedural hydration and
reducing contrast Volume
Methodology

• CA-AKI was defined as a post-PCI increase in serum creatinine of > 0.5 mg/dL or
a relative increase of > 25% compared with pre-PCI

• Prospective Study of 200 patients undergoing PCI with one or more DES

• Multivariable model, older age, female sex, Congestive heart failure, diabetes, hypertension,
CKD with CrCL, eGFR , presentation with ST-segment elevation MI, Killip class ,Radial access,
intra-aortic balloon pump use, hypotension, Adhoc PCI, GRACE, TIMI score, and the Procedural
approach, Single/Staged PCI, Number of stents, prior FFR, Diagnostic CAG prior to PTCA
• Pre and Post procedural Hydration with IV Fluids Sodium bicarbonate , Total Contrast Volume
INCLUSION AND EXCLUSION CRITERION

INCLUSION

All patients of PCI with one or more DES

EXCLUSION

All patients of FFR not requiring DES, Diagnostic Coronary Arteriogram with plan of Medical
Management.
Proforma
Name UHID No Date CAG Date of PCI Date of PCI 2

Age Sex DM HTN Baseline Post Procedural eGFR CrCl LVEF CKD
Creatini Day 3 Creatinine
ne

PCI CAG Prior IV Procedure No of MC Procedural Total CA AKI

Contrast Contrast Hydratio Sodium Radial/ Stents Suppor Aids Contrast Yes/No
n IV Bicarbon Femoral t IVL/Rota (ml)
Fluids ate IABP