Creatine kinase-MB and red cell distribution width as predictors of contrast-induced nephropathy after percutaneous coronary intervention in acute myocardial infarction.

INTRODUCTION: Contrast-induced nephropathy (CIN) is acute kidney injury (AKI), caused by administration of iodinated contrast media. The reported risk factors of CIN are: pre-existing renal dysfunction, admission anemia, diabetic nephropathy, old age, dehydration, high volume and osmolarity of administered contrast media. Patients with acute myocardial infarction (AMI) have threefold higher risk of developing CIN. The aim of the study was to identify risk factors of CIN among patients who underwent percutaneous coronary intervention (PCI) due to AMI. METHODS: This retrospective single-centre study included 257 patients (mean age, 69.19 ± 1.4 years; men 66.15%) undergoing PCI for AMI between January 2012 and January 2013. Demographic data, type and location of MI, co-morbidities and laboratory results were analysed. RESULTS: CIN was found in 50 out of 257 patients (19.5%). Patients who developed CIN were older (p = 0.001), more commonly had chronic kidney disease (p = 0.01) and lower LVEF (p = 0.01). Baseline Red Cell Distribution Width (RDW) was significantly higher in the CIN group (14.85 ± 4.6 vs. 13.62 ± 1.3, p = 0.001). CK-MB levels on admission were significantly higher in the CIN group compared to the non- CIN group (95.6 ± 129.9 vs. 47.03 ± 61.3, p = 0.001). Multivariate model including "classical" CIN risk actors revealed that only baseline CK-MB level (p = 0.001), age >75 years (p = 0.001) and baseline RDW (p = 0.03) were independent predictors for the development of CIN. CONCLUSION: In conclusion, increased CK-MB on admission as a surrogate of time of ischemia, and increased RDW levels on admission as a marker of chronic in ammation are independently associated with higher risk of CIN among patients treated with primary PCI.

Direct left ventricular wire pacing during transcatheter aortic valve implantation.

BACKGROUND: Rapid ventricular pacing is used during balloon aortic valvuloplasty, balloon­expandable transcatheter aortic valve implantation (TAVI), and for postdilatation. Right ventricular (RV) lead pacing has been regarded as a gold standard. Direct left ventricular (LV) wire pacing has recently been considered safe and effective in TAVI interventions. AIMS: This study aimed to analyze procedural outcomes of direct LV pacing compared with RV stimulation in unselected patients undergoing TAVI. METHODS: Direct LV wire pacing was provided via available preshaped guidewires and used only when no predictors of atrioventricular block were present. The primary study objective was the assessment of the efficacy of direct LV wire pacing. The secondary objectives included the evaluation of procedure duration and safety in comparison with the conventional method. A combined endpoint (major adverse cardiovascular event) was defined as the occurrence of death, stroke, venous puncture-related complications, and cardiac tamponade. RESULTS: In 2017 and 2018, 143 patients underwent transfemoral TAVI. Of these, 114 (79.7%) had self­ ­expandable valves implanted. Direct LV wire pacing was the dominant method of pacing (82 patients [57.3%]), and its efficacy reached 97.6%. The median (interquartile range) procedure time was shorter in the direct LV wire pacing group (80 [70-90] min vs 85 [70-95] min; P = 0.02). Major adverse cardiovascular events were more frequent in the RV lead pacing group (11.5% vs 4.9%), but no statistical significance was achieved (P = 0.13). CONCLUSIONS: Direct LV wire pacing during TAVI is a simple, reproducible, and safe technique, which provides reliable, sustained stimulation with a low complication rate and potential reduction of procedural time.