Koroner no-reflow fenomeninde kontrast ilişkili akut böbrek hasarını öngördüren faktörler

Giriş: Perkutan koroner girişim (PKG) uygulananlarda, koroner no-reflow fenomeni genellikle TIMI (Miyokard Enfarktüsünde Tromboliz) skorunun değerlendirilmesi ile belirlenir. Kontrast kaynaklı akut böbrek hasarı (CI-AKI) da bu hastalarda sık görülen bir problem olmuştur. Bu çalışmada, koroner no-reflow fenomeni olan hastalarda CI-AKI gelişimi için potansiyel risk faktörlerini değerlendirmeyi amaçladık. Yöntemler: Kardiyoloji kliniğimize 2014-2019 yılları arasında PKG uygulanan ardışık koroner arter hastalığı (KAH) hastalarını dahil ettik. Çok değişkenli lojistik regresyon analizi ile PKG sonrası no-reflow fenomeni gelişen hastalarda CI-AKI ile ilişkili bağımsız değişkenler değerlendirildi. İstatistiksel anlamlılık sınırı olarak bir P değeri <0.05 kabul edildi. Bulgular: 3034 hastadan oluşan popülasyondan 93'üne (% 3) koroner no-reflow (% 64 erkek, ortalama yaş 64 ± 12) tanısı kondu. CI-AKI koroner no-reflow saptanan hastaların % 22'sinde görüldü (n = 20). Çok değişkenli analiz, PKG sonrası TIMI akım 0-1, kontrast miktarı ve pulmoner arteriyel hipertansiyonun (PHT) koroner no-reflow fenomeninde CI-AKI' nin gelişimi ile anlamlı ilişkilerini göstermiştir (p:0.023, p:0.017 ve p<0.001). Sonuç: PKG ile yönetilen KAH hastalarında, PHT, PKG sonrası TIMI akım ve ayrıca mevcut koroner ektazi varlığı, koroner no-reflow fenomeni olan hastalarda LVEF değerlerinden bağımsız olarak CI-AKI gelişimi için önemli bir risk oluşturmaktadır.

Anahtar Kelimeler:

Koroner arter hastalığı, kontrast ilişkili, no-reflow fenomeni, akut böbrek hasarı

Predictive Factors of Contrast-induced Acute Kidney Injury in the Setting of Coronary No-reflow Phenomenon

Introduction: In subjects undergoing percutaneous coronary intervention (PCI), coronary no-reflow phenomenon is generally determined through evaluation of TIMI (Thrombolysis In Myocardial Infarction) score. Contrast-induced acute kidney injury (CI-AKI) has also been a frequent problem in these patients. The purpose of this study is aimed to evaluate potential risk factors of CI-AKI in subjects with coronary no-reflow phenomenon. Methods: We enrolled consecutive patients with coronary artery disease (CAD) undergoing PCI between the years 2014 and 2019 in cardiology clinic. Independent variables associated with CI-AKI in patients with no reflow phenomenon following PCI were evaluated using multivariate logistic regression analysis. A p value <0.05 was accepted as the statistical significance limit. Results: Among a population of 3034 patients, 93 (3%) were diagnosed as having coronary no-reflow (64% male, mean age of 64±12 years). CI-AKI occurred in 22% of the patients with coronary no-reflow (n:20). The multivariate analysis has demonstrated significant associations of post PCI TIMI flow 0-1, contrast volume and pulmonary arterial hypertension (PHT) with the evolution of CI-AKI in the setting of no-reflow phenomenon (p:0.023, p:0.017 and p<0.001). Conclusion: In CAD patients managed with PCI, PHT, contrast volume, post-PCI TIMI flow as well as the presence of coronary ectasia may pose a significant risk for CI-AKI development in subjects with coronary no-reflow phenomenon.

Keywords:

Coronary artery disease, contrast-induced, no-reflow phenomenon, acute kidney injury,

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