ABSTRACT
BACKGROUND AND OBJECTIVES: The risk of contrast-induced nephropathy (CIN) is significantly influenced by baseline renal function and the amount of contrast media (CM). We evaluated the usefulness of the cystatin C (CyC) based estimated glomerular filtration rate (eGFR(CyC)) in the prediction of CIN and to determine the safe CM dosage. SUBJECTS AND METHODS: We prospectively enrolled a total of 723 patients who received percutaneous coronary intervention (PCI) and investigated the clinical factors associated with the development of CIN. Renal function was calculated as eGFR(CyC) and a modified diet in the renal disease (MDRD) equation, respectively. Systemic exposure of CM was calculated as CM volume to eGFR ratio. We conducted a regression analysis to evaluate the predictive role of CM volume to eGFR(CyC) for the risk of CIN. RESULTS: The incidence of CIN was 4.0% (29/723). The patients with CIN had a lower hemoglobin level, decreased renal function, and a higher CyC value, and had greater CM exposure. Through multivariate regression analyses, hemoglobin {odds ratio (OR) 0.743, p=0.032}, CM volume/eGFR(CyC) (OR 1.697, p=0.006) and CM volume/MDRD (OR 2.275, p<0.001) were found to be independent predictors for CIN. In the receiver operating characteristic curve analysis, fair discrimination for CIN was found at a CM volume/eGFR(CyC) level of 4.493 (C-statics=0.814), and at this value, the sensitivity and specificity were 79.3% and 80.0%, respectively. CONCLUSION: Both the CM volume/MDRD and CM volume/eGFR(CyC) method would be simple, useful indicators for determining the safe CM-dose based on eGFR value before PCI. However, there was no significantly different predictive value between creatinine and CyC based GFR estimations.
Subject(s)
Humans , Acute Kidney Injury , Contrast Media , Creatinine , Cystatin C , Diet , Discrimination, Psychological , Glomerular Filtration Rate , Hemoglobins , Incidence , Percutaneous Coronary Intervention , Prospective Studies , ROC Curve , Sensitivity and SpecificityABSTRACT
No abstract available.
Subject(s)
Humans , Male , Middle Aged , Alveolitis, Extrinsic Allergic/chemically induced , Biopsy , Drug Hypersensitivity/diagnosis , Drug-Eluting Stents/adverse effects , Percutaneous Coronary Intervention/adverse effects , Sirolimus/adverse effects , Steroids/therapeutic use , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
No abstract available.
Subject(s)
Aged , Female , Humans , Bone Cements/adverse effects , Cardiac Surgical Procedures , Echocardiography , Foreign-Body Migration/diagnosis , Heart Atria/surgery , Heart Ventricles/surgery , Tomography, X-Ray Computed , Treatment Outcome , Vertebroplasty/adverse effectsABSTRACT
Heparin is an essential drug in the treatment of acute coronary syndrome and it is used during percutaneous coronary intervention (PCI). Heparin-induced thrombocytopenia (HIT), albeit a serious complication of heparin therapy characterized by thrombocytopenia and high risk for venous and arterial thrombosis, has rarely been previously reported during PCI. We report a case of an acute stent thrombosis due to an unusual cause, HIT during primary PCI, in a patient with acute myocardial infarction.
Subject(s)
Humans , Acute Coronary Syndrome , Heparin , Myocardial Infarction , Percutaneous Coronary Intervention , Stents , Thrombocytopenia , ThrombosisABSTRACT
BACKGROUND AND OBJECTIVES: Anticoagulation with vitamin K antagonists (VKAs) such as warfarin provides effective stroke prophylaxis in patients with atrial fibrillation (AF). We conducted a large multicenter survey of Korean patients with AF to determine trends in VKA use. SUBJECTS AND METHODS: Eligible patients were adults with AF that had been prescribed VKAs. Medical records from a total of 5616 patients {mean age 63.6+/-12.2 years, male 3150 (56.1%)} in 27 hospitals from Jan. 2001 to Oct. 2007 were reviewed. RESULTS: The mean international normalized ratio (INR) was 2.04+/-0.64, and mean dosage of VKA was 3.66+/-1.50 mg. Individuals in their sixties (1852 patients) accounted for about one third of patients studied. As patients grew older, INR increased and VKA dosage decreased. The dosage of VKA in male patients was larger than that in females for all ages. A total of 2146 (42.4%) patients had an INR of 2-3, and less than 40% patients in their sixties had an INR within optimal range. The dosage of oral anticoagulant for optimal INR level was 3.71 mg. CONCLUSION: In this study, less than half of the Korean patients with AF on VKA reached the therapeutic range of INR. Mean dosage of VKA was 3.66+/-1.50 mg, and the dosage of oral anticoagulant for optimal INR level was 3.71 mg, which decreased with age.
Subject(s)
Adult , Female , Humans , Male , Anticoagulants , Atrial Fibrillation , International Normalized Ratio , Medical Records , Stroke , Vitamin K , WarfarinABSTRACT
Carcinoid heart disease is characterized by heart valve dysfunction as well as carcinoid symptomatology. We report a case of carcinoid heart disease associated with a primary ovarian tumor. A 60-year-old woman presented for dyspnea evaluation with a history of facial flushing, telangiectatic skin changes, and pitting edema of both lower extremities. Chest radiography showed cardiomegaly, and echocardiography revealed an isolated, severe tricuspid regurgitation without left-sided valvular dysfunction. The tricuspid leaflets were severely retracted and shortened, resulting in poor coaptation. Furthermore, mild pulmonary valve stenosis and moderate regurgitation were found along with this deformation. The 24-hour urine analysis revealed an increased level of 5-hydroxyindoleacetic acid, and an ovarian tumor was apparent on computed tomography images. The mass was surgically removed, and the patient was diagnosed as having a primary ovarian carcinoid tumor. She was treated with chemotherapy and regularly followed-up with supportive treatments, deferring surgical correction.
Subject(s)
Female , Humans , Middle Aged , Carcinoid Heart Disease , Carcinoid Tumor , Cardiomegaly , Dyspnea , Echocardiography , Edema , Flushing , Heart Valves , Lower Extremity , Pulmonary Valve Stenosis , Skin , Thorax , Tricuspid Valve InsufficiencyABSTRACT
BACKGROUND/AIMS: In patients with heart failure (HF), N-terminal prohormone brain natriuretic peptide (NT-ProBNP) is a standard prognostic indicator. In addition, uric acid (UA) was recently established as a prognostic marker for poor outcome in chronic HF. The aim of this study was to determine the combined role of UA and NT-ProBNP as prognostic markers for short-term outcomes of acute heart failure (AHF). METHODS: The levels of UA and NT-ProBNP were determined in 193 patients (age, 69 +/- 13 years; 76 males) admitted with AHF. Patients were followed for 3 months and evaluated for cardiovascular events, defined as cardiac death and/or readmission for HF. RESULTS: Of the 193 patients, 23 (11.9%) died and 20 (10.4%) were readmitted for HF during the 3-month follow-up period. Based on univariate analysis, possible predictors of short-term cardiovascular events were high levels of UA and NT-ProBNP, low creatinine clearance, no angiotensin converting enzyme inhibitors or angiotensin receptor blockers, and old age. Multivariate Cox hazard analysis showed that UA levels were independently associated with increased incidence of cardiovascular events (hazard ratio, 1.115; 95% confidence interval, 1.006 to 1.235; p = 0.037). Kaplan-Meier survival analysis revealed that patients with UA levels > 8.0 mg/dL and NT-ProBNP levels > 4,210 pg/mL were at highest risk for cardiac events (p = 0.01). CONCLUSIONS: The combination of UA and NT-ProBNP levels appears to be more useful than either marker alone as an independent predictor for short-term outcomes in patients with AHF.