Incidence of contrast-induced nephropathy in complete revascularization versus culprit-only in diabetic elderly patients with acute STEMI and multi-vessel disease

Author(s): Mohamed Atef Hamza, Ahmed Behiery, Nireen Okasha, Mohamed Zahran

Background: Complete revascularization of significant non culprit lesions is associated with better outcomes in ST Elevation Myocardial Infarction (STEMI) patients regarding Major Adverse Cardiac Events (MACE), however the incidence of Contrast Induce Nephropathy (CIN) in diabetic and elderly patients is unclear.

Objectives: To investigate whether an index procedure complete revascularization approach is associated with increased risk of CIN in diabetic elderly patients presented with STEMI and multi-vessel disease.

Methods: This study enrolled 140 diabetic elderly patients with acute STEMI and at least one non-culprit lesion, randomized to either complete revascularization (n=70) or culprit-only treatment (n=70). Complete revascularization was performed at the time of Primary Percutaneous Coronary Intervention (PPCI). The primary endpoint was the incidence of CIN or renal dialysis at one month.

Results: A complete revascularization approach was significantly associated with higher risk of CIN (21.4% vs. 7.1; p=0.01), with no significant difference in the other endpoints of mortality, renal replacement therapy, major or minor bleeding between the groups.

Conclusion: In diabetic elderly STEMI patients, with multi-vessel coronary artery disease undergoing PPCI, complete revascularization during index procedure is associated with significantly higher risk of CIN, compared with culprit vessel only PCI.