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

Autor:	Briguori C; Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy. Electronic address: carlobriguori@clinicamediterranea.it., Quintavalle C; Center for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Naples, Italy., Mariano E; Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy., D'Agostino A; Division of Cardiology, Paolo Giaccone University Hospital, Palermo, Italy., Scarpelli M; Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy., Focaccio A; Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy., Zoccai GB; Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy; Center for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Naples, Italy; Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy; Division of Cardiology, Paolo Giaccone University Hospital, Palermo, Italy; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy., Evola S; Division of Cardiology, Paolo Giaccone University Hospital, Palermo, Italy., Esposito G; Department of Advanced Biomedical Science, Division of Cardiology, Federico II University of Naples, Naples, Italy., Sangiorgi GM; Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy., Condorelli G; Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy; Scientific Institute for Research, Hospitalization, and Health Care-Mediterranean Neurological Institute (IRCCS Neuromed), Pozzilli, Italy.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2024 Mar 19; Vol. 83 (11), pp. 1059-1069.
DOI:	10.1016/j.jacc.2024.01.016
Abstrakt:	Background: Acute kidney injury (AKI) is common in patients with acute coronary syndromes (ACS) treated by percutaneous coronary intervention. Objectives: 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. Methods: 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. Results: 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). Conclusions: 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). Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose. The company providing the DyeVert system (Osprey Medical, Inc) was not involved in the trial design and conduction. (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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