Statin therapy reduces contrast-induced nephropathy: an analysis of contemporary percutaneous interventions

We sought to examine whether statin therapy before percutaneous coronary intervention results in reduction in contrast-induced nephropathy (CIN). Intravascular administration of contrast media can have nephrotoxic effects, particularly in patients with baseline renal insufficiency. Along with loweri...

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Published in:	The American journal of medicine Vol. 118; no. 8; p. 843
Main Authors:	Khanal, Sanjaya, Attallah, Nizar, Smith, Dean E, Kline-Rogers, Eva, Share, David, O'Donnell, Michael J, Moscucci, Mauro
Format:	Journal Article
Language:	English
Published:	United States 01.08.2005
Subjects:	Angioplasty, Balloon, Coronary Cardiovascular Diseases - therapy Contrast Media - adverse effects Creatinine - blood Female Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Kidney Diseases - chemically induced Kidney Diseases - prevention & control Kidney Function Tests Male Middle Aged Multivariate Analysis Preoperative Care Prospective Studies Registries
ISSN:	0002-9343
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Abstract	We sought to examine whether statin therapy before percutaneous coronary intervention results in reduction in contrast-induced nephropathy (CIN). Intravascular administration of contrast media can have nephrotoxic effects, particularly in patients with baseline renal insufficiency. Along with lowering serum cholesterol, statins have pleiotropic effects in the vasculature. The effect of statin use on CIN is unknown. We studied 29409 patients who had both baseline preprocedure and peak postprocedure serum creatinine measured at the time of their percutaneous coronary intervention (PCI). Baseline demographics and creatinine profile before and after the procedure were compared between patients who received preprocedure statins and those who did not. CIN was defined as an increase in serum creatinine of < or =0.5 mg/dL. Baseline serum creatinine was similar between the two groups. When compared with patients who did not receive preprocedure statins, patients on preprocedure statins had a lower incidence of CIN (4.37 vs 5.93, P <0.0001) and nephropathy requiring dialysis (0.32 vs 0.49, P = 0.03). After adjustments for comorbidities, preprocedure statin use was associated with a significant reduction in CIN (odds ration [OR] 0.87, 95% confidence interval [CI] 0.77-0.99, P = 0.03). Preprocedure statin use is associated with significant reduction in CIN after contemporary PCI. This reinforces the need to initiate statin therapy before percutaneous coronary interventions.
AbstractList	We sought to examine whether statin therapy before percutaneous coronary intervention results in reduction in contrast-induced nephropathy (CIN). Intravascular administration of contrast media can have nephrotoxic effects, particularly in patients with baseline renal insufficiency. Along with lowering serum cholesterol, statins have pleiotropic effects in the vasculature. The effect of statin use on CIN is unknown.PURPOSEWe sought to examine whether statin therapy before percutaneous coronary intervention results in reduction in contrast-induced nephropathy (CIN). Intravascular administration of contrast media can have nephrotoxic effects, particularly in patients with baseline renal insufficiency. Along with lowering serum cholesterol, statins have pleiotropic effects in the vasculature. The effect of statin use on CIN is unknown.We studied 29409 patients who had both baseline preprocedure and peak postprocedure serum creatinine measured at the time of their percutaneous coronary intervention (PCI). Baseline demographics and creatinine profile before and after the procedure were compared between patients who received preprocedure statins and those who did not. CIN was defined as an increase in serum creatinine of < or =0.5 mg/dL.SUBJECTS AND METHODSWe studied 29409 patients who had both baseline preprocedure and peak postprocedure serum creatinine measured at the time of their percutaneous coronary intervention (PCI). Baseline demographics and creatinine profile before and after the procedure were compared between patients who received preprocedure statins and those who did not. CIN was defined as an increase in serum creatinine of < or =0.5 mg/dL.Baseline serum creatinine was similar between the two groups. When compared with patients who did not receive preprocedure statins, patients on preprocedure statins had a lower incidence of CIN (4.37 vs 5.93, P <0.0001) and nephropathy requiring dialysis (0.32 vs 0.49, P = 0.03). After adjustments for comorbidities, preprocedure statin use was associated with a significant reduction in CIN (odds ration [OR] 0.87, 95% confidence interval [CI] 0.77-0.99, P = 0.03).RESULTSBaseline serum creatinine was similar between the two groups. When compared with patients who did not receive preprocedure statins, patients on preprocedure statins had a lower incidence of CIN (4.37 vs 5.93, P <0.0001) and nephropathy requiring dialysis (0.32 vs 0.49, P = 0.03). After adjustments for comorbidities, preprocedure statin use was associated with a significant reduction in CIN (odds ration [OR] 0.87, 95% confidence interval [CI] 0.77-0.99, P = 0.03).Preprocedure statin use is associated with significant reduction in CIN after contemporary PCI. This reinforces the need to initiate statin therapy before percutaneous coronary interventions.CONCLUSIONSPreprocedure statin use is associated with significant reduction in CIN after contemporary PCI. This reinforces the need to initiate statin therapy before percutaneous coronary interventions. We sought to examine whether statin therapy before percutaneous coronary intervention results in reduction in contrast-induced nephropathy (CIN). Intravascular administration of contrast media can have nephrotoxic effects, particularly in patients with baseline renal insufficiency. Along with lowering serum cholesterol, statins have pleiotropic effects in the vasculature. The effect of statin use on CIN is unknown. We studied 29409 patients who had both baseline preprocedure and peak postprocedure serum creatinine measured at the time of their percutaneous coronary intervention (PCI). Baseline demographics and creatinine profile before and after the procedure were compared between patients who received preprocedure statins and those who did not. CIN was defined as an increase in serum creatinine of < or =0.5 mg/dL. Baseline serum creatinine was similar between the two groups. When compared with patients who did not receive preprocedure statins, patients on preprocedure statins had a lower incidence of CIN (4.37 vs 5.93, P <0.0001) and nephropathy requiring dialysis (0.32 vs 0.49, P = 0.03). After adjustments for comorbidities, preprocedure statin use was associated with a significant reduction in CIN (odds ration [OR] 0.87, 95% confidence interval [CI] 0.77-0.99, P = 0.03). Preprocedure statin use is associated with significant reduction in CIN after contemporary PCI. This reinforces the need to initiate statin therapy before percutaneous coronary interventions.
Author	Khanal, Sanjaya Attallah, Nizar Smith, Dean E O'Donnell, Michael J Moscucci, Mauro Kline-Rogers, Eva Share, David
Author_xml	– sequence: 1 givenname: Sanjaya surname: Khanal fullname: Khanal, Sanjaya email: skhanal1@hfhs.org organization: Henry Ford Heart and Vascular Institute, Henry Ford Hospital, Detroit, Mich 48202, USA. skhanal1@hfhs.org – sequence: 2 givenname: Nizar surname: Attallah fullname: Attallah, Nizar – sequence: 3 givenname: Dean E surname: Smith fullname: Smith, Dean E – sequence: 4 givenname: Eva surname: Kline-Rogers fullname: Kline-Rogers, Eva – sequence: 5 givenname: David surname: Share fullname: Share, David – sequence: 6 givenname: Michael J surname: O'Donnell fullname: O'Donnell, Michael J – sequence: 7 givenname: Mauro surname: Moscucci fullname: Moscucci, Mauro
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SubjectTerms	Angioplasty, Balloon, Coronary Cardiovascular Diseases - therapy Contrast Media - adverse effects Creatinine - blood Female Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Kidney Diseases - chemically induced Kidney Diseases - prevention & control Kidney Function Tests Male Middle Aged Multivariate Analysis Preoperative Care Prospective Studies Registries
Title	Statin therapy reduces contrast-induced nephropathy: an analysis of contemporary percutaneous interventions
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