[Influence of Loading Dose Of Atorvastatin on the Risk of Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction].

Aim      This retrospective cohort study focused on evaluating the incidence of contrast-induced nephropathy (CIN) associated with administration of an atorvastatin loading dose (80 mg) prior to invasive coronary angiography (CAG) in patients with ST-segment elevation myocardial infarction (STEMI).Material and methods  This retrospective cohort study included 386 patients with STEMI. The patients were divided into two groups: intervention group (n=118) and control group (n=268). Patients in the intervention group, at the stage of admission to the catheterization laboratory, were administered a loading dose of atorvastatin (80 mg, p.o.) immediately before access (introducer placement). The endpoints were development of CIN, which was determined by increased serum creatinine 48 h following the intervention by at least 25% (or 44 µmol/l) of baseline value. In addition, in-hospital mortality and incidence of CIN resolution were assessed. To adjust the groups for dissimilar characteristics, a "pseudorandomization" method was used by comparing propensity scores.Results The incidence of CIN was significantly lower in the intervention group than in the control group (10.5 % vs. 24.4 %; p=0.016) with the odds for the CIN development lower than in the control group (odds ratio (OR) 0.36; 95 % confidence interval (CI), 0.16-0.85). Creatinine concentrations returned to the baseline value in 7 days more frequently than in the control group (66.3 % vs. 50.6 %, respectively; OR, 1.92; 95 % CI, 1.04-3.56; p=0.037). In-hospital mortality was higher in the control group but did not differ significantly between the groups.Conclusion      ~Administration of atorvastatin 80 mg to STEMI patients immediately before CAG was associated with a reduced risk of CIN and a higher likelihood of serum creatinine returning to the values at admission by day 7.

Stenting of an endograft limb in its acute occlusion after endovascular intervention for an abdominal aortic aneurysm. / Stentirovanie branshi stent-grafta pri ee ostroi okkliuzii posle éndovaskuliarnogo vmeshatel'stva po povodu anevrizmy briushnoi aorty.

Endovascular abdominal aortic aneurysm repair (EVAR) has recently become an operation of choice in the presence of clinical, anatomic and organizational conditions for implantation of a stent graft. However, like any other operation, EVAR bears the risk of various complications. Due to low frequency of EVAR, the problem concerning appropriate policy of managing patients presenting with such types of complications may be difficult. Thrombosis of a stent graft's components is encountered more often compared with "open" prosthetic repair of the abdominal aorta. This complication more frequently requires interventions in the scope of femoro-femoral bypass grafting. Attempts of thrombextraction may lead to disconnection of a stent graft's modules and to embolic complications. Presented herein is a clinical case report wherein proceeding from objective examination and laboratory instrumental studies, namely angiography, we chose a policy of endovascular intervention (stenting) for thrombosis of a stent graft's limb. At 2 years of follow up the patient is currently in a satisfactory condition, as confirmed by the findings of MSCT angiography two years after the intervention.