Decreased glomerular filtration rate (GFR) is an important predictor of adverse cardiovascular events in acute coronary syndromes (1-5). Patients who have normal renal functions and undergo percutaneous coronary interventions (PCI) are also under risk for adverse events due to contrast induced nephropathy (CIN). (6,7)
Contrast volume is an modifiable major risk factor for CIN and closely related with in-hospital mortality (8-10). Recently the ratio of contrast volume to GFR (V/GFR) was found to be as a predictor of increase in creatinine values and CIN following PCI (11-13). However, impact of V/GFR on short and long term prognosis after primary PCI has not been evaluated so far. Therefore, ...view middle of the document...
Reperfusion time and door –to-balloon time were also recorded. On admission, blood values were obtained from all patients. Serum creatinine was also measured before the angiography procedure and within 48 hours afterward. A 12-lead ECG was recorded in each patient just after hospital admission, and the myocardial infarction type was also obtained from the ECGs. At 24 to 72 hours after revascularization ,a transthoracic echocardiography was performed by using a system V (Vingmed,GE,Horten,Norway) with a 2,5-MHz phased-array transducer, and the left ventricular ejection fraction (LVEF) was calculated using a modified Simpson’s method.( 15)
2.3 Coronary angiography and PCI
All patients were given a chewable 300 mg aspirin and clopidogrel (600 mg loading dosage) before coronary angiography. After the procedure, all patients were prescribed aspirin (100 mg once daily) and clopidogrel (75 mg once daily). Angiographic data of the patients were assessed from catheter laboratory records. All procedures were performed via femoral route. A nonionic, low osmolar contrast agent Ultravist (Iopromide, 370 mgI/mL Bayer HealthCare Pharmaceuticals Inc.Germany) was utilized in all patients. The artery that was anticipated to be unhindered was injected first. Heparin (100 IU/kg) was administered when the coronary anatomy was first described. After visualizing the left and right coronary arteries, 2.5 μg of nitrate was selectively injected into the infarct related arter (IRA) to exclude a possible coronary spasm. An angiographic evaluation was made by visual assessment. Primary angioplasty (including balloon angioplasty and/or stent implantation) was performed just for IRA according to lesion type. For each procedure, interventional success at the acute phase was defined as reducing to <30% of obstruction and stenosis of the IRA with Thrombolysis in Myocardial Infarction 3 flow just after primary angioplasty. The use of tirofiban was left to the discretion of the operator.
The time from symptom onset to the coronary reperfusion was defined as time to reperfusion with balloon inflation. Door–to-balloon time was defined as the time between emergency department and balloon inflation .Patients were assessed according to Killip clinical examination classification (16) .Advanced heart failure was defined as New York Heart Association classification of at least >3 .Non-diabetic patients were defined as the patients without documented DM using neither oral hypoglisemic agents nor insulin treatment at admission .Hypercholesterolemia was defined as total cholesterol of at least 200 mg/dlor use of cholesterol-lowering drugs.A family history of coronary artery disease (CAD) was defined as documented case of CAD in a parent or sibling before 60 years of age. Anemia was defined as the hemoglobin concentration less than 13 mg/dl in men and 12 mg/dl in women. Cardiovascular death was defined as unexplained sudden death ,death as a result of acute myocardial...