Skip Navigation

This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Brinker, J. A.
Right arrow Articles by Laskey, W.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Brinker, J. A.
Right arrow Articles by Laskey, W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: permissions@oupjournals.org

Preventing in-hospital cardiac and renal complications in high-risk PCI patients

Jeffrey A. Brinker1, Charles J. Davidson2 and Warren Laskey3,*

1Johns Hopkins Medical Institutions, Baltimore, MD, USA
2Northwestern University Medical School, Chicago, IL, USA
3UNM Health Sciences Center, School of Medicine, Department of Internal Medicine, ACC 5223, 1 University of New Mexico, Albuquerque, NM 87131-5001, USA

* Corresponding author. Tel: +1 505 272 6020. E-mail address: wlaskey{at}salud.unm.edu

Percutaneous coronary intervention, a highly effective therapy for angina, is associated with in-hospital complications including death, myocardial infarction (MI), emergency coronary artery bypass grafting, stroke, contrast-induced nephropathy (CIN), and vascular access-site problems. Patients with risk factors including advanced age, unstable angina or acute MI, impaired ejection fraction, multivessel disease, peripheral vascular disease, and renal insufficiency (RI) are at increased risk of major adverse cardiac events (MACE). Furthermore, patients with RI, diabetes, congestive heart failure, hypertension, or pre-procedure shock are at increased risk of CIN, which may result in renal failure as well as increased morbidity and mortality from cardiovascular disease. Algorithms have been developed to predict the likelihood of peri-procedural MACE or CIN for individual patients, and at-risk patients should be managed carefully. Measures to avoid MACE include use of antithrombotic therapies such as aspirin, thienopyridines, glycoprotein Gp IIb/IIIa inhibitors, and anticoagulants. In addition, evidence shows that the use of the iso-osmolar, non-ionic, dimeric contrast medium iodixanol may reduce the in-hospital incidences of both MACE (particularly MI) and CIN when compared with the low-osmolar contrast media that it has been tested against. Other approaches to avoid CIN include discontinuation of nephrotoxic drugs, such as non-steroidal anti-inflammatory medications, use of a minimum volume of contrast, provision of intravenous hydration for 24 h beginning before the procedure, and possibly administration of N-acetylcysteine.

Key Words: Contrast-induced nephropathy • CIN • Renal insufficiency • Contrast media • Osmolality • Major adverse cardiac events • MACE • Risk assessment


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.