Impact of metabolic syndrome on development of contrast-induced nephropathy after elective percutaneous coronary intervention among nondiabetic patients

Abstract

Background: Identifying patients who are vulnerable to development of contrast-induced nephropathy (CIN) is essential because of its association with prolonged hospitalization, increased cost, and increased in-hospital and long-term mortality rates.

Hypothesis: Individual components of metabolic syndrome (MetS) are well-established risk factors for kidney injury. Nondiabetic patients diagnosed with MetS might be at an increased risk of developing CIN after elective percutaneous coronary intervention (PCI).

Methods: A total of 599 nondiabetic patients were enrolled, of whom 313 met the MetS criteria and 286 were included in the control group. Patients were evaluated for development of CIN after elective PCI.

Results: Contrast-induced nephropathy occurred in 9.3% (29 of 313) of the MetS group and 4.9% (14 of 286) of the control group (P = 0.04). The multivariable regression model revealed that baseline glomerular filtration rate < 30 mL/min, multivessel intervention, and MetS increased and use of statin decreased the probability of CIN independent from confounding factors (odds ratio [OR]: 7.84, 95% confidence interval [CI]: 3.46-24.36, P < 0.01 for baseline glomerular filtration rate < 30 mL/min; OR: 0.82, 95% CI: 0.42-0.96, P = 0.02 for statin use; OR: 2.64, 95% CI: 1.46-6.56, P < 0.01 for multivessel intervention; and OR: 1.66, 95% CI: 1.12-2.61, P = 0.03 for MetS).

Conclusions: Metabolic syndrome is a risk factor for CIN in patients with stable coronary artery disease who undergo elective PCI. We suggest that clinicians recognize the patients with MetS before elective coronary interventions.

Trial registration: ClinicalTrials.gov NCT02192372.

© 2015 Wiley Periodicals, Inc.

Figures

Figure 1

Flow diagram of patients. The diagram includes detailed information on the excluded patients. Abbreviations: CIN, contrast‐induced nephropathy; MetS, metabolic syndrome.

Figure 2

ROC curve analysis of GFRs for the prediction of CIN. (A) Patients with MetS. © = Cutoff value for GFR: 67.3 mL/min. Sensitivity 59%, specificity 73%. AUC: 0.687, 95% CI: 0.609‐0.766, P = 0.036. (B) Patients without MetS. © = Cutoff value for GFR: 59.1 mL/min. Sensitivity 54%, specificity 72%. AUC: 0.564, 95% CI: 0.483‐0.646, P = 0.07. Abbreviations: AUC, area under the curve; CI, confidence interval; CIN, contrast‐induced nephropathy; GFR, glomerular filtration rate; MetS, metabolic syndrome; ROC, receiver operating characteristic.