Contrast-induced acute kidney injury in patients with myocardial infarction non obstruction and with coronary artery obstruction

Goal. To conduct a comparative assessment of renal function, risk factors and the incidence of contrast-induced nephropathy (CIN) in patients with MINOCA and MICAD, including taking into account the value of the left ventricular global function index (LVGFI).

Material and methods. The study involved 170 patients diagnosed with myocardial infarction. The diagnosis was established in accordance with the Fourth Universal Definition. According to the results of coronary angiography (CAG), patients were divided into 2 groups: 1 – myocardial infarction without coronary artery obstruction (MINOCA), n=73,2 – myocardial infarction with coronary artery obstruction (MICAD), n=97, who, according to indications, underwent stenting of the infarct-associated coronary artery. According to the magnitude of the LVGFI, patients are divided into 2 subgroups: 1 – low LVGFI (<31,2%), 2 – normal LVGFI (>31,2%). The glomerular filtration rate (GFR) was estimated according to the formula CKD – Epi 2011 at admission, 24 hours and 48 hours after the procedure. The CIN criterion is an increase in serum creatinine levels by 26,5 mmol/l or more within 48 hours after administration of an X-ray contrast agent (RVC).

Results. In patients with MICAD, the risk of AKI CIN is the same. Patients with MICAD required a higher amount of PCI (89.8 ml, p<0.001). The estimated risk of CIN, taking into account the amount of RCF used, is higher in patients with low LVGFI in the MICAD group (6.5 points versus 4 points, p=0.028). Patients with MINOCA with LVGFI >31.2% required a larger volume of PCI (200 ml and 199 ml in patients with LVGFI <31.2%, p=0.041). Patients with CIN in the MINOCA group tended to have higher creatinine (110 and 92 mmol/L, p=0.08). No differences in the main risk factors were found in patients with MICAD who had and had not had acute kidney injury due to contrast-induced nephropathy.

Conclusion. The risk and prevalence of AKI are the same in patients with MINOKA and MICAD. Patients with MICAD needed more RCB. Depending on the LVGFI value, renal function, the occurrence of risk factors for acute kidney injury, and the prevalence of CIN OP did not differ. Patients with MINOCA with CIN had higher pre-procedure creatinine levels.

1. Lavrishcheva Yu.V., Konradi A.O., Yakovenko A.A. i dr. Methodological aspects of the prevention of contrast-induced acute kidney injury during angiographic studies and interventions using radiocontrast agents. Translational medicine. 2020;7(4):83-90. (In Russ.). https://doi.org/10.18705/2311-4495-2020-7-4-83-90

2. Demchuk O.V., Sukmanova I.A., Ponomarenko I.V. Contrast-induced nephropathy in patients with acute coronary syndrome: clinical significance, diagnosis, prophylaxis. Cardiovascular Therapy and Prevention. 2020;19(2):2255. (In Russ.). https://doi.org/10.15829/1728-8800-2019-2255

3. Mironova O.Yu., Sivakova O.A., Fomin V.V. Contrast – induced nephropathy in patients with stable coronary heart disease and one-year prognosis. Eurasian heart journal. 2020;(3):100-105 (In Russ.). https://doi.org/10.38109/2225-1685-2020-3-100-105

4. Ursta A.A., Khar'kov E.I., Petrova M.M., Kotikov A.R., Ursta O.V. Probability of developing contrast-induced acute kidney injury in patients with acute myocardial infarction after coronary angiography and percutaneous coronary intervention. Russian Journal of Cardiology. 2021;26(8):4424. (In Russ.). https://doi.org/10.15829/1560-4071-2021-4424

5. Odajima S, Fujimoto W, Kuroda K, Yamashita S, Imanishi J, Iwasaki M, Todoroki T, Okuda M, Hayashi T, Konishi A, Shinohara M, Toh R, Hirata KI, Tanaka H. Association of congestion with worsening renal function in acute decompensated heart failure according to age. ESC Heart Fail. 2022 Dec;9(6):4250-4261. https://doi.org/10.1002/ehf2.14157

6. Yang Y, George KC, Luo R, et al. Contrast-induced acute kidney injury and adverse clinical outcomes risk in acute coronary syndrome patients undergoing percutaneous coronary intervention: a meta-analysis. BMC Nephrol. 2018;19(1):374. https://doi.org/10.1186/s12882-018-1161-5

7. Chandiramani R, Cao D, Mehran R. et al. Contrast-induced acute kidney injury. Cardiovasc Interv Ther. 2020 Jul;35(3):209-217. Epub 2020 Apr 6. PMID: 32253719. https://doi.org/10.1007/s12928-020-00660-8

8. Cousin F, Moïse M, Ilbert C, Meunier P, Jouret F. Prévention de la néphropathie aux produits de contraste iodés [Prevention of contrast-induced nephropathy]. Rev Med Liege. 2024 Jun;79(5- 6):418-423. French. PMID: 38869133.

9. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD; ESC Scientific Document Group. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019 Jan 14;40(3):237-269. PMID: 30165617. https//doi.org/10.1093/eurheartj/ehy462

10. [Kapustina A.Yu., Minushkina L.O., Alekhin M.N., Selezneva N.D., Safaryan V.I., Brazhnik V.A. et al. Left Ventricular Global Function Index as a Predictor of Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome. Kardiologiia. 2021;61(8):23-31. (In Russ.). https://doi.org/10.18087/cardio.2021.8.n1508

11. Zalewska-Adamiec M, Malyszko J, Grodzka E, Kuzma L, Dobrzycki S, Bachorzewska-Gajewska H. The outcome of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and impaired kidney function: a 3-year observational study. Int Urol Nephrol. 2021 Dec;53(12):2557-2566. Epub 2021 Feb 18. PMID: 33599901; PMCID: PMC8599341. https://doi.org/10.1007/s11255-021-02794-x

12. Shishkina E.A., Khlynova O.V., Cheremnykh A.B. Prediction of post-hospital mortality in young and middle-aged patients with myocardial infarction. Doktor.Ru. 2020;19(5):24-29. (In Russ.). https://doi.org/10.31550/1727-2378-2020-19-5-24-29

13. Kanic V, Kompara G, Vollrath M, Suran D, Kanic Z. Age-Specific Sex- Based Differences in Anemia in Patients with Myocardial Infarction. J Womens Health (Larchmt). 2019 Jul;28(7):1004-1010. Epub 2019 Jan 11. PMID: 30632879. https://doi.org/10.1089/jwh.2018.7211

14. Khalfallah M, Abdalaal M, Adel M. Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction: Is it Affected by Treatment Strategy? Glob Heart. 2019 Sep;14(3):295- 302. PMID: 31451237. https://doi.org/10.1016/j.gheart.2019.07.001

15. He H, Chen XR, Chen YQ, Niu TS, Liao YM. Prevalence and Predictors of Contrast-Induced Nephropathy (CIN) in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Percutaneous Coronary Intervention (PCI): A Meta-Analysis. J Interv Cardiol. 2019 Aug 25;2019:2750173. PMID: 31772520; PMCID: PMC6854223. https://doi.org/10.1155/2019/2750173

16. Reinstadler SJ, Klug G, Feistritzer HJ, Mayr A, Kofler M, Aschauer A, Schocke M, Müller S, Franz WM, Metzler B. Left ventricular global function index: Relation with infarct characteristics and left ventricular ejection fraction after STEMI. Int J Cardiol. 2014 Aug 20;175(3):579-81. Epub 2014 Jun 10. PMID: 24953868. https://doi.org/10.1016/j.ijcard.2014.06.004