Hongliang Cong

Risk Score for the Prediction of Contrast-Induced Nephropathy in Elderly Patients Undergoing Percutaneous Coronary Intervention

We developed a risk score for contrast-induced nephropathy (CIN) in elderly patients (n = 668) before percutaneous coronary intervention (PCI). Another 277 elderly patients were studied for validation. Based on the odds ratio, risk factors were assigned a weighted integer; the sum of the integers was the risk score. Among the 668 elderly patients, 105 (15.7%) experienced CIN. There were 9 risk factors for CIN (with weighted integer): estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 (4), diabetes (3), left ventricular ejection fraction <45% (3), hypotension (2), age >70 years (2), myocardial infarction (2), emergency PCI (2), anemia (2), and contrast agent volume >200 mL (2). The incidence of CIN was 3.4%, 11.9%, 36.9%, and 69.8% in the low-risk (≤4), moderate risk (5-8), high-risk (9-12), and very-high-risk groups (≥13). The model demonstrated good discriminative power in the validation population (c statistic = 0.79). This score can be used to plan preventative measures.

A simple preprocedural score for risk of contrast‐induced acute kidney injury after percutaneous coronary intervention

To develop a simple scoring system based on preprocedural clinical features that is capable of predicting contrast‐induced acute kidney injury (CI‐AKI) before percutaneous coronary intervention (PCI).

Is angiotensin-converting enzyme inhibitor appropriate for contrast-induced nephropathy? A meta-analysis about this field

cultured in the presence of healthy subject erythrocytes (Fig. 1). The production of the pro-inflammatory cytokine IL-12p70 was higher in LPS-stimulated iDCs cultured in the presence of patient erythrocytes than in those cultured in the presence of healthy control erythrocytes (Pb.05) whereas IL-10 did the contrary (Pb0.001) (Fig. 2A). LPS-stimulated iDCs cultured in the presence of patient erythrocytes increased the proliferation of allogeneic CD4+ T cells evaluated by H-methyl-thymidine incorporation in a standard mixed lymphocyte reaction (Fig. 2B). To sum up we state that erythrocytes from patients with carotid atherosclerosis fail to control DC maturation. Changes in their integrity and functions, probably due to erythrocyte exposure to high oxidative stress generated by atherosclerotic risk factors such as diabetes, smoking, hypercholesterolemia, may cause the impairment of erythrocyte immunomodulatory activity, thus contributing to atherosclerotic plaque progression and destabilization. We suggest that the altered expression of CD47 at erythrocyte surface, or its loss due to vesiculation, could represent themainmechanism determining the functional impairment of patient erythrocytes in their cross-talk with DCs.

Preventive Effects of Alprostadil Against Contrast-Induced Nephropathy Inpatients With Renal Insufficiency Undergoing Percutaneous Coronary Intervention.

We investigated the preventive effect of alprostadil on contrast-induced nephropathy (CIN) in patients with renal insufficiency undergoing percutaneous coronary intervention (PCI). A total of 300 patients with creatinine clearance (crCl) ≤60 mL/min undergoing PCI were randomly assigned to alprostadil or a control group. The primary end point was the incidence of CIN defined as an increase in serum creatinine (Scr) levels by ≥0.5 mg/dL or≥ 25% after administration of the contrast media within 72 hours. The secondary end points were (1) changes in Scr and crCl within 72 hours and (2) the incidence of major adverse events during hospitalization. The incidence of CIN was 2.7% (4/150) in the alprostadil group, and 8.7% (13/150) in the control group (χ2 = 5.05, P = .043).There was no difference regarding the incidence of major adverse events during hospitalization between the alprostadil group and control groups (2.7% vs 4.0%, P = .750). Multivariate logistic regression analysis showed that alprostadil was an independent protective factor for CIN (odds ratio = 0.136, 95% confidence interval: 0.020-0.944, P = .044). Prophylactic administration of alprostadil may prevent CIN in patients with renal insufficiency undergoing PCI.

ATORVASTATIN COMBINED WITH PROBUCOL CAN REDUCE SERUM URIC ACID'S LEVEL DURING PERIOPERATIVE PERIOD OF INTERVENTION

Objectives To observe the effect of different doses of atorvastatin combined with different dose of probucol on the level of serum uric acid in patients undergoing coronary angiography or percutaneous coronary intervention (PCI). Methods 208 cases enrolled in our study were randomly divided into three groups: Standard combining treatment group (n=55): Atorvastatin 20 mg qn and Probucol 0.25 g/bid; Intensively combining treatment group (n=79): Atorvastatin 40 mg qn and Probucol 0.5 g/bid, with a further dose of Atorvastatin 40 mg and Probucol 0.5 g 2 h before the angioplasty; Intensive Atorvastatin group (n=74): Atorvastatin 40 mg qn, with a futher dose of Atorvastatin 40 mg 2 h before the angioplasty. Blood urea nitrogen (BUN), serum creatinine (Scr), serum uric acid (SUA), and estimated glomerular filtration rate (eGFR) (through MDRD method) of all patients were tested at the times of 24 h before and 24 h after the procedure. Results (1) After operation, BUN of all groups decreased; Scr in Standard combining treatment group and Intensive Atorvastatin group increased significantly; while eGFR decreased only in Standard combining treatment group (p<0.05); there was no significant difference in Scr and eGFR between 24 h and 24 h after intervention in Intensively combining treatment group (p>0.05); (2) SUA in Standard combining treatment group and Intensively combining treatment group decreased significantly after operation (p<0.05), while no significant change in Intensive Atorvastatin group (p>0.05). (3) For hypertensive patients, Scr in Standard combining treatment group and Intensive Atorvastatin group increased significantly (p<0.05), as eGFR of the two groups decreased; in Intensively combining treatment group, BUN and SUA decreased markedly, while Scr and eGFR showed no significant changes. Conclusions Preoperative combination treatment of Atorvastatin and Probucol could reduce perioperative serum uric acids level, whats more with a intensive treatment of future dose of Atorvastatin 40 mg and Probucol 0.5 g 2 h before the angioplasty could also improve CIAKI. For hypertensive patients, intensively combining treatment could not only reduce serum uric acids level, but also improve CIAKI.

RISK SCORE FOR PREDICTION OF CONTRAST INDUCED NEPHROPATHY IN HAN CHINESE UNDERWENT PERCUTANEOUS CORONARY INTERVENTION

Objectives To develop a simplified risk score of contrast induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for Han Chinese. Methods A retrospective study was performed on 1500 patients for the development dataset, who had undergone PCI from January 2008 to May 2010. And one thousand patients treated in the same period were selected for the validation set. Logistic regression analysis was applied to identify risk factors for CIN. Based on the OR, the sum of the integers was a total risk score for each patient. Results (1) Among the 1500 patients, CIN occurred in 246 patients and the overall incidence of CIN was 16.4%. (2) Eleven identified variables were identified as risk factors for CIN (with weighted integer): diabetes (3 score), hypotension (3 score), Left ventricular ejection fraction (LVEF≤45%) (3 score), eGFR <60 ml/min/1.73 m2 (3 score), age>70 years (2 score), myocardial infarction (2 score), emergency PCI (2 score), anaemia (2 score), decreased high-density lipoprotein (HDL) concentration (<1 mmol/l) (2 score), contrast agent dose of >200 ml (2 score), low permeability contrast agent (1 score). (3) The sum of the integers was a total risk score for each patient. The incidence of CIN was 5.2% in low risk group (≤4), 13.6% in the moderate risk group (5–10), 32.3% in the high risk group (11–14) and 59.0% in the very high risk group (≥15). (4) The model demonstrated good discriminative power in the validation population, showing that the increasing risk score was strongly associated with CIN (c-statistic=0.82). Conclusions This simple scoring system proposed here provides a good estimate of the risk of CIN after PCI for Han Chinese. This risk score can be used for the prevention and treatment of CIN.