SIGNIFICANCE OF LEFT VENTRICULAR END DIASTOLIC PRESSURE FOR RISK STRATIFICATION OF CONTRAST-INDUCED ACUTE KIDNEY INJURY AFTER PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Abstract

Objectives: The objective of this study was to determine the significance of left ventricular end diastolic pressure (LVEDP) for risk stratification of contrast-induced acute kidney injury after primary percutaneous coronary intervention (PCI).

Methodology: This cross-sectional study was conducted at the largest cardiac care center of the Pakistan. Consecutive patients presented to the emergency department and diagnosed with ST-segment elevation myocardial infarction (STEMI) undergone primary PCI were included. Serum creatinine level were obtained at baseline and after 48 to 72 hours and contrast induced nephropathy (CIN) was recorded. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive strength of LVEDP and area under the curve (AUC) was reported.

Results: Out of 488 cases, seventy-two (14.8%) patients developed CIN. Left ventricular end diastolic pressure predicted CIN with an AUC of 0.582 [95% CI: 0.510 to 0.654], the optimal cut-off value of LVEDP ≥ 20 mmHg yielded overall classification accuracy of 49.2% (95% CI: 44.7% to 53.7%) with sensitivity of 66.7% (95% CI: 54.6% to 77.3%) and specificity of 46.1% (95% CI: 41.3% to 51.1%). The predictive accuracy increased as patients ejection fraction decreased, LVEDP predicted CIN with an AUC of 0.623 [95% CI: 0.540 to 0.707] among patients with LVEF ≤40%, while, the AUC of LVEDP for predicting CIN was 0.504 [95% CI: 0386 to 0.622] for patients with LVEF > 40%.

Conclusion: Elevated intra-procedural LVEDP (≥20mmHg) is independently associated with an increased risk of CI-AKI for patients undergoing cardiac catheterization and PCI, especially in the setting of reduced LVEF (≤40%).