Contrast-induced acute kidney injury in patients with myocardial infarction non obstruction and with coronary artery obstruction

Goal. To conduct a comparative assessment of renal function, risk factors and the incidence of contrast-induced nephropathy (CIN) in patients with MINOCA and MICAD, including taking into account the value of the left ventricular global function index (LVGFI). Material and methods. The study involved 170 patients diagnosed with myocardial infarction. The diagnosis was established in accordance with the Fourth Universal Definition. According to the results of coronary angiography (CAG), patients were divided into 2 groups: 1 – myocardial infarction without coronary artery obstruction (MINOCA), n=73,2 – myocardial infarction with coronary artery obstruction (MICAD), n=97, who, according to indications, underwent stenting of the infarct-associated coronary artery. According to the magnitude of the LVGFI, patients are divided into 2 subgroups: 1 – low LVGFI (<31,2%), 2 – normal LVGFI (>31,2%). The glomerular filtration rate (GFR) was estimated according to the formula CKD – Epi 2011 at admission, 24 hours and 48 hours after the procedure. The CIN criterion is an increase in serum creatinine levels by 26,5 mmol/l or more within 48 hours after administration of an X-ray contrast agent (RVC). Results. In patients with MICAD, the risk of AKI CIN is the same. Patients with MICAD required a higher amount of PCI (89.8 ml, p<0.001). The estimated risk of CIN, taking into account the amount of RCF used, is higher in patients with low LVGFI in the MICAD group (6.5 points versus 4 points, p=0.028). Patients with MINOCA with LVGFI >31.2% required a larger volume of PCI (200 ml and 199 ml in patients with LVGFI <31.2%, p=0.041). Patients with CIN in the MINOCA group tended to have higher creatinine (110 and 92 mmol/L, p=0.08). No differences in the main risk factors were found in patients with MICAD who had and had not had acute kidney injury due to contrast-induced nephropathy. Conclusion. The risk and prevalence of AKI are the same in patients with MINOKA and MICAD. Patients with MICAD needed more RCB. Depending on the LVGFI value, renal function, the occurrence of risk factors for acute kidney injury, and the prevalence of CIN OP did not differ. Patients with MINOCA with CIN had higher pre-procedure creatinine levels.