Impact of Gender on the Incidence and Outcome of Contrast-Induced Nephropathy After Percutaneous Coronary Intervention

Contrast-induced nephropathy (CIN) may occur after percutaneous coronary interventions (PCI), particularly in patients with baseline chronic renal failure (CRF) and diabetes mellitus.1–3 We have reported on the adverse impact of CIN post-PCI in patients with CRF (creatinine rise of at least 25% from baseline within 48 hours after PCI).4 In the present study, we analyzed the impact of gender on development and outcome of CIN in a large cohort of PCI patients (with or without CRF). Methods Patient population. From a total of 8,628 consecutive patients undergoing PCI (angioplasty, stenting, directional atherectomy, rotablation) between January 1994 and June 1999 at the Washington Hospital Center, we identified 1431 patients (16.5%) who developed CIN, defined as >= 25% rise in serum creatinine value compared to pre-PCI or new requirement for hemodialysis. CIN patients were further examined according to a 4 group classification with respect to 1-year outcome: females with CRF (F/CRF, n = 89 patients, 96 procedures), females with no CRF (F/no CRF, n = 465 patients, 525 procedures), males with CRF (M/CRF, n=177 patients, 194 procedures) and males without CRF (M/no CRF, n=710 patients, 763 procedures). CRF was defined as a baseline (pre-PCI) serum creatinine value >= 1.5mg/dl. Procedures. All patients underwent cardiac catheterization and PCI by standard techniques using the femoral approach.5,6 After informed consent was obtained, operators selected interventional devices and radiocontrast agent at their discretion. All patients received ionic low-osmolar contrast agents; in particular. Patients with CRF received intravenous hydration with half normal saline at 75–100 ml/hours for 12–24 hours before the procedure and for 12 to 24 hours after the procedure. Pre-specified clinical and laboratory demographic information was obtained from hospital charts that were reviewed by independent research personnel unaware of the objectives of the study. Creatinine levels were obtained routinely in CRF patients at baseline, day 1 and day 2 post-PCI. Long-term clinical follow-up was performed by either telephone contact or office visit at 1, 3, 6 and 12 months. For patients who could not be contacted in office visits, a written questionnaire sent to the referral physician, with informed and consenting permission of the patient, was used. All events were source-documented and adjudicated. Data were obtained from the computerized database of the Cardiovascular Research Foundation. These data collection methods and detailed variable descriptions have been published previously.7,8 Statistical analysis. Statistical analysis was performed using SAS (Statistical Analysis Systems, SAS Institute Inc, Cary, North Carolina). Continuous variables are expressed as mean ± standard deviation and categorical variables as number (%). Continuous variables were estimated using analysis of variance (ANOVA) or Student’s t-test. Categorical variables were compared with a chi-square or Fisher’s exact test. A p value Incidence and predictors of CIN. Of a total 8,628 patients who underwent PCI, there were 1,431 (16.5%) who developed CIN. Baseline patient characteristics according to group classification described above are shown in Table 1. CIN was present in 552 (23.6%) of female versus 17.4% (879) of male patients (p Outcome of CIN. Procedural results are shown in Table 3. Angiographic success was similarly high in all groups. The contrast amount used and ratio of contrast to BSA were significantly higher in M/no CRF compared to F/CRF group. There were no differences regarding these parameters in patients with baseline CRF. In-hospital outcomes are presented in Table 4. There was trend (p = 0.06) towards higher rates of in-hospital mortality and Q-wave MI, and significantly higher rates (p Study limitations. This analysis was retrospective; however, the data were collected prospectively by independent monitors and entered into a dedicated database, and selection of the data fields was done on a pre-specified and prospective basis. We obtained follow-up information from telephone interviews with patients and their family members for 93% of the patients. However, it is possible that patients may have been lost to follow-up because of adverse event; we attempted to rectify this limitation with appropriate statistical models. We should also mention the small numbers of patients with chronic renal failure in our study population. Another limitation of our study is the definition of CIN (increase in the serum creatinine concentration of at least 25% compared to the pre-PCI values) and CRF (baseline creatinine > 1.5 mg/dl) without estimation of the relationship to creatinine clearance among the study groups; however, these CIN and CRF definitions have been found to be clinical important in previous reports.4,9–11 Conclusions. Female gender is an independent predictor of CIN development and a marker of worse 1-year mortality after CIN in patients without CRF. After CIN is developed, pre-PCI CRF, diabetes mellitus, age, severe heart failure (not gender) are independent predictors of one-year mortality.

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