Prospective Randomized Trial of Na/K Citrate for the Prevention of Contrast-Induced Nephropathy in High-risk Patients.

Background: Contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury (CI-AKI) refers to an acute kidney injury (AKI) occurring after exposure to contrast media, commonly used in diagnostic procedures or therapeutic angiographic interventions. Recently, Na/K citrate, used for urine alkalinization, has been assessed for preventing CIN. This experiment evaluated Na/K citrate's efficacy in preventing CIN in high-risk patients undergoing cardiac catheterization. Methods: A prospective randomized clinical trial involved 400 patients with moderate- to high-risk factors for CIN undergoing elective percutaneous coronary intervention (PCI). They were randomly assigned to either the control or Na/K citrate groups. The Na/K citrate group (n = 200) received a 5 g Na/K citrate solution diluted in 200 mL water 2 hours before and 4 hours after the first administration, along with intravenous hydration for 2 hours before and 6 hours after the procedure. In contrast, the control group (n = 200) received only intravenous hydration. Serum creatinine (SCr) levels were measured before contrast exposure and 48 hours afterward. CIN was defined as a 25% increase in serum creatinine (SCr) or > 0.5 mg/dL 48 hours after contrast administration. The significance level was set at P ˂ 0.05. Results: CIN was observed in 33 patients (16.5%) in the control group and 6 patients (3%) in the Na/K citrate group. The incidence of CIN was found to have a significant difference between the 2 groups 48 hours after receiving the radiocontrast agent (P < 0.001). Conclusion: Our results show that Na/K citrate is helpful and substantially reduces the incidence of CIN.

Effect of COVID-19 medications on corrected QT interval and induction of torsade de pointes: Results of a multicenter national survey.

BACKGROUND: There are some data showing that repurposed drugs used for the Coronavirus disease-19 (COVID-19) have potential to increase the risk of QTc prolongation and torsade de pointes (TdP), and these arrhythmic side effects have not been adequately addressed in COVID-19 patients treated with these repurposed medications. METHODS: This is the prospective study of 2403 patients hospitalised at 13 hospitals within the COVID-19 epicentres of the Iran. These patients were treated with chloroquine, hydroxychloroquine, lopinavir/ritonavir, atazanavir/ritonavir, oseltamivir, favipiravir and remdesivir alone or in combination with azithromycin. The primary outcome of the study was incidence of critical QTc prolongation, and secondary outcomes were incidences of TdP and death. RESULTS: Of the 2403 patients, 2365 met inclusion criteria. The primary outcome of QTc ≥ 500 ms and ∆QTc ≥ 60 ms was observed in 11.2% and 17.6% of the patients, respectively. The secondary outcomes of TdP and death were reported in 0.38% and 9.8% of the patients, respectively. The risk of critical QT prolongation increased in the presence of female gender, history of heart failure, treatment with hydroxychloroquine, azithromycin combination therapy, simultaneous furosemide or beta-blocker therapy and acute renal or hepatic dysfunction. However, the risk of TdP was predicted by treatment with lopinavir-ritonavir, simultaneous amiodarone or furosemide administration and hypokalaemia during treatment. CONCLUSION: This cohort showed significant QTc prolongation with all COVID-19 medications studied, however, life-threatening arrhythmia of TdP occurred rarely. Among the repurposed drugs studied, hydroxychloroquine or lopinavir-ritonavir alone or in combination with azithromycin clearly demonstrated to increase the risk of critical QT prolongation and/or TdP.

Persistent Complete Heart Block in a Patient with COVID-19 Infection: a Case Report.

The pandemic of COVID-19 as a global concern has emerged the need for data aggregation about various clinical pictures particularly cardiovascular complications. Although the incidence of advanced atrioventricular block (AVB) in these patients is not well established, few cases have been reported. We have reported a 48-year-old man with COVID-19 infection who presented with prodromal symptoms for 5 days preceding complete AVB found at the emergency department. Pulmonary involvement and PCR confirmed the diagnosis. The block persisted after recovery of the patient for more than 1 month. Pathophysiology of advanced AVB following COVID-19 infection is not well understood. Several factors including inflammatory response, immune system over activity, myocarditis, and medications have been underlined. Although conservative management may lead to spontaneous recovery of AVB, pacemaker implantation is reasonable in case of persistent conduction defect.

In-Hospital Clinical Outcomes and Procedural Complications of Percutaneous Coronary Intervention in Elderly Patients.

BACKGROUND: As population growth leads to an increase in the number of the elderly with coronary artery disease, an evaluation of the clinical outcomes of percutaneous coronary intervention (PCI) in the elderly patients seems to be essential. METHODS: A prospective, observational cohort study was performed on 468 patients in two groups of elderly and non-elderly patients (mean age: 60.01 ± 10.84 years; ≥ 70 years, 20.1%; men, 62%) who underwent PCI, to evaluate the procedural success and in-hospital major and minor adverse cardiovascular events in the elderly patients. RESULTS: The procedural success rate was significantly lower (95.7% vs. 99.5%, P = 0.017) and the rates of in-hospital complications were significantly higher (10.6% vs. 0.8%, P < 0.0001) in elderly (+70) than in non-elderly patients. On the basis of a multivariate analysis, being elderly was not an independent predictor of procedural failure, but increased the chance of in-hospital complications to 8% higher (odds ratio: 0.08; 95% confidence interval: 0.01 - 0.39; P = 0.002). CONCLUSION: Regardless of the difference in the procedural success and in-hospital complication rates between our two study groups, aging is not an important predictor of them. Furthermore, PCI should not be refused in elderly patients if indicated.

Efficacy of nicorandil treatment for prevention of contrast-induced nephropathy in high-risk patients undergoing cardiac catheterization: A prospective randomized controlled trial.

BACKGROUND: Contrast-induced nephropathy (CIN) remains to be a potentially serious complication of radiographic procedures and is the third leading cause of the acute kidney injury (AKI) among hospitalized patients. This clinical trial was performed to assess the preventive effect of oral nicorandil on CIN in high-risk patients undergoing cardiac catheterization. METHODS: In this prospective, randomized, controlled trial, 128 patients with at least two risk factors for CIN undergoing elective percutaneous coronary intervention (PCI) were randomly assigned to either the nicorandil group or the control group. Patients in the nicorandil group (n = 64) received 10 mg nicorandil, daily from 30 min before and up to 3 days after procedure and intravenous hydration for 2 h before and 6 h after the procedure, whereas patients in the control group (n = 64) just received intravenous hydration. Serum creatinine (SCr) was measured before contrast exposure and at 72 h. CIN was defined as an increase of 25% in SCr or > 0.5 mg/dL 72 h after contrast administration. RESULTS: Contrast-induced nephropathy occurred in 14 out of 64 (21.9%) patients in the control group and in 3 out of 64 (4.7%) patients in the nicorandil group. There was a significant difference in the incidence of CIN between the two groups at 72 h after administering the radiocontrast agent (p = 0.008). Moreover, there were significant differences between the two groups in SCr and estimated glomerular filtration rate 72 h after radiocontrast administration (p < 0.05). CONCLUSIONS: The findings revealed that oral nicorandil had substantial efficacy over hydration protocol for the development of CIN in high-risk patients undergoing cardiac catheterization.

Allopurinol prophylactic therapy and the prevention of contrast-induced nephropathy in high-risk patients undergoing coronary angiography: A prospective randomized controlled trial.

BACKGROUND: Contrast-induced nephropathy (CIN) is considered to be a possibly severe complication of radiography and thus, remains to be the main cause of acute kidney injury (AKI) for inpatients. A clinical trial was executed to measure the preventive effect of allopurinol against CIN in high-risk patients undertaking coronary angiography. METHODS: Through randomized controlled trial, 140 patients with at minimum two risk factors of CIN, undertaking coronary angiography, were randomly allocated to the allopurinol (n = 70) or control group (n = 70). Those in the allopurinol group received allopurinol (300 mg) a day before their coronary angiography and intravenous hydration for 12 hours before and after their procedure, while members of the control group only received intravenous hydration. Serum creatinine (SCr), blood urea nitrogen (BUN) and uric acid were measured before and 48 hours after the procedure. CIN was defined by a 25% increase in SCr or the concentration of > 0.5 mg/dl, 48 hours after coronary angiography. RESULTS: CIN was observed in 8 (11.4%) patients in the allopurinol group and 11 (15.7%) patients in the control group. There was no significant difference in the incidence of CIN between the two groups at 48 hours after coronary angiography (P = 0.459). In the allopurinol group, the median SCr concentration decreased non-significantly from 1.16 mg/dl to 1.13 mg/dl, 48 hours after coronary angiography (P = 0.189). In the control group, the median SCr concentration increased significantly from 1.11 mg/dl to 1.2 mg/dl, 48 hours after coronary angiography (P < 0.001). CONCLUSION: Allopurinol presents no considerable effectiveness over the hydration protocol for development of CIN in high-risk patients.

Saliva-based creatine kinase MB measurement as a potential point-of-care testing for detection of myocardial infarction.

Myocardial infarction (MI) is the main cause of death all over the world. Biomarkers of cardiac necrosis are of great importance in the diagnosis of MI. The aim of this study was to determine probable changes of creatine kinase MB isoform (CK-MB) levels in saliva of patients with acute MI. A case-control study was carried out on 30 patients with acute MI who were hospitalized in Kamkar-Arabnia Hospital of Qom City and 30 healthy control subjects. CK-MB levels were measured by immunoinhibition assay in saliva and serum of patients and healthy individuals. Statistical analysis of the Student's t test and Pearson correlation coefficient was used. CK-MB levels showed a significant elevation in saliva and serum of patients with acute MI compared to healthy controls. Furthermore, there was a strong correlation between salivary levels of CK-MB and its serum values. Subsequent to an acute MI, there is a rise in salivary levels of CK-MB just as what occurs in the serum. Moreover, salivary levels of CK-MB reflect well its serum values. It seems that cardiac biomarker CK-MB is measurable in the saliva of patients with acute MI. Salivary CK-MB may serve as an easy-to-use diagnostic tool for point-of-care testing of acute MI.