Kidney Injury After Minimal Radiographic Contrast Administration in Patients With Acute Coronary Syndromes

医学 经皮冠状动脉介入治疗 急性肾损伤 临床终点 心肌梗塞 肌酐 随机对照试验 内科学 急性冠脉综合征 心脏病学 外科
作者
Carlo Briguori,Cristina Quintavalle,Enrica Mariano,Alessandro D’Agostino,Mario Scarpelli,Amelia Focaccio,Giuseppe Biondi‐Zoccai,Salvatore Evola,Giovanni Esposito,Giuseppe Sangiorgi,Gerolama Condorelli
出处
期刊:Journal of the American College of Cardiology [Elsevier BV]
卷期号:83 (11): 1059-1069 被引量:4
标识
DOI:10.1016/j.jacc.2024.01.016
摘要

Acute kidney injury (AKI) is common in patients with acute coronary syndromes (ACS) treated by percutaneous coronary intervention. Contrast media (CM) volume minimization has been advocated for prevention of AKI. The DyeVert CM diversion system (Osprey Medical, Inc) is designed to reduce CM volume during coronary procedures. In this randomized, single-blind, investigator-driven clinical trial conducted in 4 Italian centers from February 4, 2020 to September 13, 2022, 550 participants with ACS were randomly assigned in a 1:1 ratio to the following: 1) the contrast volume reduction (CVR) group (n = 276), in which CM injection was handled by the CM diversion system; and 2) the control group (n = 274), in which a conventional manual or automatic injection syringe was used. The primary endpoint was the rate of AKI, defined as a serum creatinine (sCr) increase ≥0.3 mg/dL within 48 hours after CM exposure. There were 412 of 550 (74.5%) participants with ST-segment elevation myocardial infarction (211 of 276 [76.4%] in the CVR group and 201 of 274 [73.3%] in the control group). The CM volume was lower in the CVR group (95 ± 30 mL vs 160 ± 23 mL; P < 0.001). Seven participants (1 in the CVR group and 6 in the control group) did not have postprocedural sCr values. AKI occurred in 44 of 275 (16%) participants in the CVR group and in 65 of 268 (24.3%) participants in the control group (relative risk: 0.66; 95% CI: 0.47-0.93; P = 0.018). CM volume reduction obtained using the CM diversion system is effective for prevention of AKI in patients with ACS undergoing invasive procedures. (REnal Insufficiency Following Contrast MEDIA Administration TriaL IV [REMEDIALIV]: NCT04714736)
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