الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Acute hyperglycemia and contrast -induced nephropathy in patients undergoing primary percutaneous coronary intervention
For patients with ST-segment elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PCI) is superior to fibrinolytic therapy alone in reducing the composite end points of death, re-infarction, intracranial bleeding, re-occlusion of the infarct artery, and recurrent ischemia.
Patients undergoing primary PCI, however, are at high risk for contrast-induced nephropathy (CIN), a complication that has a serious impact on in-hospital outcome and may partially thwart the overall benefit of primary PCI.
An increased mortality risk has also been documented in STEMI patients with increased glucose levels at hospital presentation (acute hyperglycemia), even in those without established diabetes mellitus.
This study included 100 patients that presented to the emergency department of the National Heart Institute with acute ST- elevation myocardial infarction and were treated with primary PCI.
This study was aiming to determine the association between admission glucose levels and the risk of subsequent CIN in patients with STEMI who undergo primary PCI. In-hospital mortality rate and other major adverse events were evaluated as secondary end points.
All the patients were subjected to full history taking with special emphasis on known predisposing factors for CIN, through clinical examination, Primary PCI was performed by a 24-hours on-call interventional team according to standard clinical practice, an echocardiographic evaluation, serum creatinine was measured at the time of admission (just before primary PCI), and every day for the following three days in the CCU.
In the current study, all in-hospital complications occurred more frequently in the hyperglycemic group with statistically significant difference regarding VF, mechanical ventilation, cardiogenic shock and mortality.
There was positive correlation between admission serum glucose level and the incidence of CIN, which was also the case with admission serum creatinine, but at the levels recorded for patients in this study this relation was statistically highly significant with acute hyperglycemia. Also, in this study group, hypertension and dyslipidemia had positive correlation with the incidence of CIN.
In our study population, acute hyperglycemia was associated with a significant increase of CIN risk among patients who did not have known DM as well as those with DM. In the patients included in our study DM was not statistically significant as acute hyperglycemia as a risk factor for CIN.
Furthermore, after adjustment of all confounding variables, patients with admission hyperglycemia had 10 times the risk of developing CIN compared to normoglycemic patients, which strongly supports a causative relationship between high glucose levels and risk of acute renal dysfunction.
Based on the results of the current study it can be concluded that:
In STEMI patients treated with primary PCI, acute hyperglycemia is closely associated with CIN risk and in-hospital morbidity and mortality.