Volume 25, Issue 108, February, 2021

Incidence of contrast-induced nephropathy in complete versus culprit only revascularization in old patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Ahmed Behiery^1♦, Nireen Okasha², Mohamed Atef³, Mohamed Zahran⁴

¹Cardiology Specialist, Faculty of medicine, Ainshams University, Cairo, Egypt
²Professor of Cardiology, Faculty of medicine, Ainshams University, Cairo, Egypt
³Assistant Professor of Cardiology, Faculty of medicine, Ainshams University, Cairo, Egypt
⁴Assistant Professor of Cardiology, Faculty of medicine, Ainshams University, Cairo, Egypt

^♦Corresponding author
Cardiology Specialist, Faculty of medicine, Ainshams University, Cairo, Egypt; Email: ahmedbehiery2010@yahoo.com

ABSTRACT

Objectives: To compare complete revascularization with a culprit-only revascularization in patients presenting with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. Background: Although several trials have compared complete with culprit-only revascularization in STEMI, it remains unclear whether complete revascularization may lead to improvement in hard endpoints (death, contrast-induced nephropathy and renal hemodialysis). Methods: It’s a cohort trial, the patients in our study were randomized into 2 groups; one of them had complete revascularization while the other group had culprit-only revascularization. Results: Our study including a total of 140 patients. 70 patients had complete revascularization, 65 patients at immediate procedure and 6 patients within 72h from initial procedure. The other 70 patients had only culprit revascularization. The exclusion criteria included patients who had chronic total occlusion (CTO) or creatinine clearance <30ml/min. Compared with a culprit-only strategy, complete revascularization had significantly higher risk for contrast induced nephropathy (CIN) p=0.016 but no significant difference between the two groups regarding renal replacement therapy during hospital stay or within one month p=0.15,p=0.31 respectively. There is also no significant difference between the two groups regarding one month mortality p=0.31. Conclusions: culprit-only revascularization reduces the risk of CIN in patients presenting by STEMI but don’t differ in incidence of mortality or renal replacement therapy.

Keywords: complete revascularization; culprit; STEMI; Primary PCI; cardiogenic shock

Medical Science, 2021, 25(108), 477-485

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