scholarly journals Left Ventricular End-Diastolic Pressure and B-Type Natriuretic Peptide Levels Guidance of Low-Dose Furosemide Treatment to Prevent Contrast-Induced Nephropathy in Patients with Percutaneous Coronary Intervention: A Randomized Controlled Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Guoqiang Gu ◽  
Demin Liu ◽  
Rui Lu ◽  
Wei Cui
Keyword(s):  
Low Dose ◽  
Diastolic Pressure ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Control Group ◽  
Contrast Induced Nephropathy ◽  
Percutaneous Coronary ◽  
Adequate Hydration ◽  
Furosemide Administration ◽  
Experimental Group

Objective. We aimed to explore the preventive effect of low-dose furosemide administration guided by left ventricular end-diastolic pressure (LVEDP) and B-type natriuretic peptide (BNP) based on adequate hydration on contrast-induced nephropathy (CIN) in patients with percutaneous coronary intervention (PCI). Methods. This parallel randomized clinical trial was conducted at a tertiary hospital in China. A total of 1053 consecutive patients (71.98% men) who underwent PCI at our hospital were enrolled. Pre-PCI plasma BNP levels were recorded. Patients enrolled received a continuous intravenous infusion of normal saline starting 4 h before PCI until 24 h after surgery. LVEDP was measured immediately after surgery. Patients in the control group received intravenous furosemide injection (20 mg). Patients in the experimental group received furosemide if they showed LVEDP ≥15 mmHg, a post-PCI BNP level ≥100 pg/mL, and/or a post-PCI BNP value > 150% of the pre-PCI value. The primary and secondary outcome measures were serum creatinine levels, glomerular filtration rate, and creatinine clearance rate measured before and after PCI. CIN incidence was compared between the two groups. Logistic regression analysis was used to study the risk factors for CIN. Results. CIN incidence was significantly higher in the control group than in the experimental group ( P < 0.05 ). Logistic regression analysis showed that elevated LVEDP and BNP levels were risk factors. As LVEDP increased, the CIN incidence also increased (odds ratio (OR) 1.038, 95% confidence interval (CI) 1.006–1.070). The OR of BNP was 1.001 (95% CI 1.000–1.002). Conclusions. Low-dose furosemide administration guided by LVEDP or BNP is superior to direct low-dose administration on the basis of adequate hydration during PCI. This trial is registered with ChiCTR-IOR-14005250

scholarly journals Targeting elevated left ventricular end-diastolic pressure following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction – a phase one safety and feasibility study

2018 ◽  
Vol 9 (7) ◽  
pp. 758-763 ◽  
Author(s):  
Arshad A Khan ◽  
Allan J Davies ◽  
Nicholas J Whitehead ◽  
Michael McGee ◽  
Mohammed S Al-Omary ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Glyceryl Trinitrate ◽  
Primary Percutaneous Coronary Intervention ◽  
Diastolic Pressure ◽  
Intervention Group ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Control Group ◽  
St Segment Elevation ◽  
Percutaneous Coronary

Introduction: Elevated left ventricular end diastolic pressure (LVEDP) is an independent predictor of mortality and heart failure in patients with ST-segment elevation myocardial infarction (STEMI). Whether lowering elevated LVEDP improves outcomes remains unknown. Methods: This non-randomized, single blinded study with prospective enrolment and sequential group allocation recruited patients undergoing primary percutaneous coronary intervention for STEMI with LVEDP ⩾ 20 mmHg measured immediately after primary percutaneous coronary intervention. The intervention arm ( n=10) received furosemide 40 mg intravenous bolus plus escalating doses of glyceryl trinitrate (100 µg per min to a maximum of 1000 µg) during simultaneous measurement of LVEDP. The control group ( n=10) received corresponding normal saline boluses with simultaneous measurement of LVEDP (10 readings over 10 min). Efficacy endpoints were final LVEDP achieved, and the dose of glyceryl trinitrate needed to reduce LVEDP by ⩾ 20%. Safety endpoint was symptomatic hypotension (systolic blood pressure < 90 mmHg). Results: From 1 April 2017 to 23 August 2017 we enrolled 20 patients (age: 64±9 years, males: 60%, n=12, anterior STEMI: 65%, n=13). The mean LVEDP for the whole cohort ( n=20) was 29±4 mmHg (intervention group: 28±3 mmHg vs. control group: 31±5 mmHg; p=0.1). The LVEDP dropped from 28±3 to 16±2 mmHg in the glyceryl trinitrate + furosemide group ( p <0.01) but remained unchanged in the control group. The median dose of glyceryl trinitrate required to produce ⩾ 20% reduction in LVEDP in the intervention group was 200 µg (range: 100–800). One patient experienced asymptomatic decline in systolic blood pressure to below 90 mmHg. There was no correlation between LVEDP and left ventricular ejection fraction. Conclusion: The administration of glyceryl trinitrate plus furosemide in patients with elevated LVEDP following primary percutaneous coronary intervention for STEMI safely reduces LVEDP.

Effect of Alprostadil on the Prevention of Contrast-Induced Nephropathy: A Meta-Analysis of 36 Randomized Controlled Trials

Angiology ◽  
2019 ◽  
Vol 70 (7) ◽  
pp. 594-612 ◽  
Author(s):  
Jian Xie ◽  
Mingyang Jiang ◽  
Yunni Lin ◽  
Huachu Deng ◽  
Lang Li
Keyword(s):  
Cystatin C ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Control Group ◽  
Contrast Induced Nephropathy ◽  
Percutaneous Coronary ◽  
Intrarenal Blood Flow ◽  
And Control ◽  
Experimental Group ◽  
Different Doses

Contrast-induced nephropathy (CIN) is the third leading cause of acquired acute renal injury in hospitalized patients. Alprostadil plays a role in the maintenance and redistribution of intrarenal blood flow and the excretion of electrolytes and water. However, the effectiveness of alprostadil in preventing CIN remains controversial. Thirty-six articles with a total of 5495 patients were included in this study. Both groups (experimental group and control group) received standard hydration therapy. In the experimental group, patients received different doses of alprostadil. Serum creatinine (SCr), blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), cystatin C, creatinine clearance rate (CCr), and β2-microglobulin (β2-MG) were measured at 24, 48, and 72 hours after contrast media injection. The incidence of CIN in the experimental group was significantly lower than that in the control group (6.56% vs 16.74%). The level of SCr, cystatin C, BUN, and β2-MG in the experimental group was lower than those in the control group; CCr and eGFR in the experimental group were higher than those in the control group. This study demonstrated that alprostadil may reduce the incidence of CIN in patients undergoing coronary angiogram and/or percutaneous coronary intervention.

Effect of Antiplatelet Therapy Combining Aspirin with Tirofiban After Percutaneous Coronary Intervention on the Incidence of Re-occlusion of Blood Vessels and Platelet Aggregation Rate in Patients with Acute Myocardial Infarction

2021 ◽  
Vol 7 (5) ◽  
pp. 4049-4056
Author(s):  
Tongtong Wu ◽  
Fang Cheng
Keyword(s):  
Platelet Aggregation ◽  
Blood Vessels ◽  
Antiplatelet Therapy ◽  
Peak Velocity ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Control Group ◽  
Aggregation Rate ◽  
Percutaneous Coronary ◽  
Experimental Group

Objective. To explore the effect of antiplatelet therapy combining aspirin with tirofiban after percutaneous coronary intervention (PCI) on the incidence of re-occlusion of blood vessels and platelet aggregation rate in patients with acute myocardial infarction (AMI). Methods. A total of 104 AMI patients treated in the Department of Cardiovascular Medicine of our hospital from March 2017 to March 2018 were selected for retrospective analysis, and those who met the inclusion criteria were divided into the experimental group (n=52) and the control group (n=52) by sealed envelope randomization. After admission, all patients received the PCI, then the combined therapy of aspirin and tirofiban was given to the patients in the experimental group, and the patients in the control group orally took the clopidogrel. By detecting the values of n-terminal pro-brain natriuretic peptide (NT-proBNP) level, platelet active function indicators, etc. of patients in both groups after treatment, the treatment effect of antiplatelet in AMI patients after PCI with different drugs was analyzed. Results. After treatment, the levels of the maximum platelet aggregation rate (MPAR), CD63, CD62P, MA, NT-proBNP and left ventricular end-diastolic volume (LVEDV) were significantly lower in the experimental group than in the control group (P<0.001), and the R time, K time, CI values, left ventricular ejection fraction (LVEF), the peak velocity of early diastolic wave (peak E)/peak velocity of late diastolic wave (peak A) under mitral valve (E/A) were significantly higher in the experimental group than in the control group (P<0.001), and during follow-up, the incidence rate of re-occlusion of blood vessels was significantly lower in the experimental group than in the control group (P<0.05). Conclusion. The above results indicated that combining aspirin with tirofiban has a better effect than clopidogrel in the antiplatelet therapy for AMI patients after PCI, and therefore it is recommended.

Preventive effect of trimetazidine on contrast-induced nephropathy undergoing percutaneous coronary intervention in elderly moderate and high risk diabetics stratified by mehran score

Perfusion ◽  
2020 ◽  
pp. 026765912095205
Author(s):  
Xue Zhang ◽  
Peng Zhang ◽  
Shicheng Yang ◽  
Wenyuan Li ◽  
Xiuzhen Men ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Serum Creatinine ◽  
Coronary Intervention ◽  
Low Risk ◽  
Control Group ◽  
Preventive Effect ◽  
Contrast Induced Nephropathy ◽  
Risk Population ◽  
Percutaneous Coronary

Background: The aim of this research was to use the Mehran risk score to classify elderly diabetics with coronary heart disease to assess the preventive effect of trimetazidine on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in different risk population. Methods: An uncompromised of 760 elderly diabetics that went through PCI were included in this research. The patients were first divided into three groups in the light of MRS: low-risk, moderate-risk, and high-risk group, then randomized into trimetazidine group and the control group respectively. The first endpoint was the amount of CIN, which is described as a rise in serum creatinine levels by ⩾44.2 μmol/L or ⩾25% ratio within 48 or 72 hours after medication. Second endpoint included differences in creatinine clearance rate (CrCl), blood urea nitrogen (BUN), serum creatinine (Scr), cystatin-C (Cys-C), and the incidence of major adverse events after administration. Results: In the three groups, the incidence of CIN in trimetazidine and control group was 5.0% versus 4.9%(χ2 = 0.005, p > 0.05), 8.0% versus 18.0% (χ2 = 7.685, p < 0.05), 10.4% versus 27.1% (χ2 = 4.376, p < 0.05), respectively. The multivariable logistic regression result demonstrated that trimetazidine intervention was a profitable element of CIN in moderate and high-risk groups (OR = 0.294, 95% CI 0.094-0.920, p = 0.035). Conclusion: Our study confirmed that trimetazidine can be considered for preventive treatment of CIN occurrence in elderly diabetics with moderate and high-risk population, while there is no obvious advantage compared with hydration therapy in low-risk patients.

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