Dr. Giancarlo Marenzi and colleagues at the University of Milan measured serum creatinine levels in 208 patients before primary percutaneous coronary angioplasty for AMI, and once a day for 3 days after the procedure. In 160 of these subjects, creatinine clearance at baseline was at least 60 mL/min. The remaining 48 patients had moderately impaired renal function.

In the November 2nd issue of the Journal of the American College of Cardiology, the authors report that contrast-induced nephropathy, defined as a rise in creatinine of more than 0.5 mg/dL, developed in 40 patients, 21 of whom were in the group with normal creatinine clearance initially and 19 of whom had renal insufficiency at baseline.

On multivariate analysis, age greater than 75 years, presence of an anterior infarction, an interval between infarction and reperfusion of more than 6 hours, dye volume of more than 300 mL, and use of an intra-aortic balloon were each independently correlated with contrast-induced nephropathy.

Patients with contrast-induced nephropathy had longer hospital stays, more in-hospital complications, and higher mortality, the researchers found.

"This study demonstrates that contrast-induced nephropathy is a frequent complication after primary PCI in AMI, even in patients with normal baseline renal function," the investigators write.

Given the associated complications and mortality rate, "preventive strategies are needed, particularly in high-risk patients," the authors conclude.

J Am Coll Cardiol 2004;44:1780-1785

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