The predictive value of the renal resistive index for contrast-induced nephropathy in patients with acute coronary syndrome.

ABSTRACT

BACKGROUND: Percutaneous coronary intervention (PCI) has been associated with contrast-induced nephropathy (CIN) at a rate that varies depending on the patient's risk factors. This study was conducted to evaluate the predictive value of the renal resistive index (RRI) for CIN in patients with acute coronary syndrome (ACS) undergoing PCI. METHODS: This prospective study enrolled 146 consecutive patients with ACS. Renal Doppler ultrasound examinations to measure RRI were performed pre-PCI and at 1 h and 24 h after PCI. The primary endpoint was CIN, defined as a relative (≥25%) or absolute (≥0.5 mg/dL; 44 µmol/L) increase in serum creatinine from baseline within 48 h after contrast exposure. RESULTS: CIN was identified in 31 patients (21.2%); however, none of the patients required haemodialysis. Compared to patients without CIN, higher RRIs were observed at 1 h (0.71 ± 0.05 vs. 0.65 ± 0.06, p < 0.05) and 24 h (0.70 ± 0.05 vs. 0.66 ± 0.06, p < 0.05) post-procedure in patients with CIN. The RRI rose transiently from baseline (0.68 ± 0.05) to 1 h (0.71 ± 0.05) and then tended to decline at 24 h (0.70 ± 0.05). A receiver operating characteristic curve analysis showed that the pre-procedure RRI was a powerful predictive indicator of CIN (area under the curve = 0.661, p = 0.006). The best cutoff value was 0.69 with 67.7% sensitivity and 67% specificity. Besides hyperuricemia and chronic kidney disease, the multivariate logistic regression analysis revealed that a high baseline RRI (≥0.69) was a significant predictor of CIN (odds ratio = 4.445; 95% confidence interval 1.806-10.937; p = 0.001). CONCLUSIONS: A high pre-procedural RRI appears to be independently predictive of CIN in patients with ACS undergoing PCI.