In-hospital mortality and contrast-induced nephropathy in subjects with acute coronary syndrome and renal dysfunction

Introduction:Patients with acute coronary syndrome and renal dysfunction are more likely to develop contrast-induced nephropathy after coronary angiography, which in turn increases in-hospital mortality.ST elevation myocardial infarction and left ventricular dysfunction are predictors of mortality in this scenario.Objective: To describe the clinical characteristics of patients with acute coronary syndrome and renal dysfunction who developed contrast-induced nephropathy (CIN) after coronary angiography, predictors of its onset, and in-hospital mortality in a Colombian population.Methods: A cross-sectional analytical observational study of patients 18 years old with acute coronary syndrome and a glomerular filtration rate < 60 ml/min/1.73m 2 or criteria for acute renal failure, undergoing coronary angiography at a cardiovascular institute in Bucaramanga between 2019 and 2020, who developed contrast-induced nephropathy within 3-5 days after the index procedure.Results: Altogether, 210 patients were included, and 10.4% developed contrast-induced nephropathy.A total of 81.8% were men, with an average age of 72 years.Systemic arterial hypertension, diabetes mellitus and chronic kidney disease were the most frequent prior conditions.The anterior descending artery was most often involved.ST elevation myocardial infarction [OR = 3, 95% confidence interval (CI) = 1.0-8.9;p = 0.04), a history of chronic kidney disease (OR = 3.4; 95% CI = 1.2-9.2;p = 0.01), and systolic blood pressure 130 mmHg during angiography (OR = 4.1; 95% CI = 1.5-11.3;p = 0.006) were associated with contrast-induced nephropathy (area under 0.76).ST elevation myocardial infarction (OR = 10.2;95% CI = 2.6-38.6;p = 0.001), the presence of contrast-induced nephropathy (OR = 4.8; 95% CI = 1.2-19.4;p = 0.026), and LVEF 40% (OR = 4.2; 95% CI = 1.1-16.1;p = 0.032) were associated with in-hospital mortality (receiver operating characteristic [ROC] curve of 0.87).Conclusions: Contrast-induced nephropathy, ST elevation myocardial infarction and left ventricular dysfunction in patients with renal dysfunction were associated with a higher risk of in-hospital mortality.