الفهرس 
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Abstract
SUMMARY
E
stimated incidence of CIN from variable prospective studies varied widely and ranged from 0% and up to 24%. This is mainly due to the variation in comorbidities, basal creatinine level and other causes of acute kidney injury. The mechanism of CIN is multifactorial. It has been demonstrated that contrast media decreases the antioxidant activity in the nephron and cause direct cytotoxicity to the renal cells, as well.
The aim of this study was to study the role of a single dose of silymarin in the prevention of CIN in patients with acute ST elevation MI undergoing primary percutaneous coronary intervention
The study was done on 200 patients with acute ST segment elevation myocardial infarction who underwent primary percutaneous coronary intervention in Ain Shams University. In the ER before the intervention, patients were randomized into 2 groups. Study group: Including 100 patients who received 300 mg Aspirin, 600 mg clopidogrel and single dose of silymarin 140 mg. Control group: Including 100 patients who received 300 mg Aspirin and 600 mg clopidogrel only. A nonionic, iso-osmolar contrast material was used. Serum creatinine was measured before and 48 hours after injection of the contrast material. CIN was defined as an increase in creatinine of ≥0.5 mg/dL or ≥25% from the baseline.
Regarding our study results:
Diastolic blood pressure was significantly lower at baseline in the study group (77.07 ± 14.58 mmHg) vs (81.28±14.82mmHg) with p value 0.044. There was no statistically significant difference found between control group and study group regarding other baseline demographic and clinical variables.
Baseline serum creatinine was significantly higher in study group (1.25 ± 0.46 mg/dl) vs (1.07 ± 0.42 mg/dl) with p-value =0.004 and accordingly baseline GFR was significantly lower in the study group (79.09 ± 32.08 ml/min) vs (95.33 ± 36.19ml/min) with P-value 0.001.
The proportion of patients with a baseline serum creatinine >1.4 mg/dl considered to have renal impairment was higher in the study group 38 (38.0%) vs 22 (22.0%) with P-value 0.014.
The contrast volume was significantly higher in study group (146.76 ± 69.14 ml) vs (93.01 ± 38.40 ml) in control group with P-value <0.001. The procedure time was significantly longer in the study group (66.19 ± 20.98 min) vs (58.16 ± 16.42 min) with P-value =0.003. The fluoroscopy time was significantly lower in the study group (35.14 ± 10.18 min) vs (40.07 ± 12.39 min)
The Δ change in serum creatinine was significantly low in study group (0.18 ± 0.28mg/dl) vs (0.35 ± 0.42mg/dl) in control group with P-value 0.011. Accordingly, the GFR Δ change was significantly higher in the study group (-8.63 ± 17.43 ml/min) vs (-18.21 ± 23.95 ml/min)in control group with P-value <0.001.
A higher proportion of patients developed CIN in the control group (28 (28.0%)) vs (12 (12.0%)) in the study group with P-value =0.005
Predictors of CIN in our study:
The age of the patients who developed CIN is significantly higher than those without CIN (63.78 ± 13.74 years) vs (58.74 ± 11.21 years) respectively, with P-value 0.016.
Presence of heart failure symptoms, hypertension and diabetes mellitus found to be significantly associated with the incidence of CIN with P-value 0.048, 0.021 and 0.005 respectively.
The proportion of renal impairment/CKD was higher in patients with CIN 20 (50.0%) vs 40 (25.0%) with P-value 0.002. baseline serum creatinine in patients with CIN was significantly high (1.34 ± 0.51mg/dl) vs (1.11 ± 0.42) with P-value 0.005. Accordingly, baseline GFR in patients with CIN was significantly low (74.45 ± 35.01ml/min) vs (90.40 ± 34.46ml/min) with P-value 0.010.
Mehran score was found to be of statistical significance difference between patients with CIN 5 (4 - 9) vs 2 (0 - 5) in patients without CIN with P-value <0.001.
LVEF was significantly low in patients with CIN (38.95 ± 9.86) vs (44.09 ± 10.92) with P-value 0.007.
The Amount of the contrast volume was significantly higher in the group who developed CIN (151.05 ± 79.93ml) vs (112.09 ± 54.13) with P-value <0.001.
Serum Creatinine Δ change was significantly high in patients developed CIN (0.86 ± 0.32mg/dl) in comparison to (0.12 ± 0.17mg/dl) in patients without CIN with P-value <0.001 and accordingly the GFR Δ change was significantly low in patients with CIN in comparison to those without CIN with P-value <0.001.
In conclusion, we found a trend toward the efficacy of silymarin in preventing contrast-inducednephropathy.