CC Cardiol Croat Cardiologia Croatica Cardiol. Croat. 1848-543X 1848-5448 Croatian Cardiac Society CC_11(10-11)_463-464 10.15836/ccar2016.463 Extended Abstract Association of chronic kidney disease with periprocedural myocardial injury after elective stent implantation http://orcid.org/0000-0002-1650-4735JerkićHelenahttp://orcid.org/0000-0002-1582-1552StipinovićMariohttp://orcid.org/0000-0003-3257-110XPočanićDarkohttp://orcid.org/0000-0002-1575-1902KranjčevićStjepanhttp://orcid.org/0000-0001-7626-3534KozmarDamirhttp://orcid.org/0000-0003-1229-7983LetilovićTomislav University Hospital Merkur, Zagreb, Croatia Address for correspondence: Helena Jerkić, Klinička bolnica Merkur, Zajčeva 19, HR-10000 Zagreb, Croatia. / Phone: +385-99-4888-576 / E-mail: helenajerkic@yahoo.com 112016 11 10-11 463 464 1409201610102016 2016 Croatian Cardiac Society Keywords: coronary artery diseasechronic kidney diseaseperiprocedural myocardial injury

Objectives: Coronary artery disease (CAD) is the leading cause of mortality in patients with chronic kidney disease (CKD). Patients with CKD who undergo coronary revascularization may have more ischemic events than patients without CKD (1). The aim of this study was to determine the incidence and intensity of periprocedural myocardial injury (PMI) after elective stent implantation among patients with and without CKD.

Patients and Methods: This study prospectively included 344 consecutive patients with stable angina pectoris who underwent an elective PCI at Merkur University Hospital, Zagreb, Croatia, in a period between March 2012 and June 2015 (Table 1). Patients were divided into two groups: control group with estimated glomerular filtration rate (eGFR) > 90 ml/min/1.73m2 and the CKD group with eGFR < 90 ml/min/1.73m2, with further subdivision according to CKD stage. Serum troponin I (cTnI) concentrations were measured at baseline and at 8 and 16 hours after PCI. Periprocedural increase of cTnI above the upper reference limit (URL) was defined as PMI. If cTnI increase ≥ 5x URL, it was considered a PMI of high degree, while an increase to < 5x URL was considered a PMI of low degree (2).

Baseline characteristics of the study participants.
eGFR>90 ml/min/1.73 m2(n= 128) eGFR<90 ml/min/1.73m2(n= 216) p value
Male, n (%) 102 (79.6) 140 (64.8) <0.01
Age, years 59.7 ± 8.1 67.1 ± 10.2 <0.01
BMI>30 kg/m2 (%) 38 (29.6) 73 (33.7) 0.43
Hypertension, n (%) 112 (87.5) 201 (93.0) 0.08
Hyperlipidemia (%) 107 (83.6) 186 (86.1) 0.64
Diabetes mellitus, n (%) 38 (29.6) 83 (38.4) 0.10
Current smoker, n (%) 37 (28.9) 33 (15.3) <0.01
Previous PCI, n (%) 43 (33.6) 65 (30.1) 0.50
Previous CABG, n (%) 3 (2.3) 9 (4.1) 0.37
Medication:
ACE inhibitors, n (%) 107 (83.6) 188 (87.1) 0.47
ARB, n (%) 11 (8.6) 22 (10.2) 0.62
Beta blockers, n (%) 110 (85.9) 177 (81.9) 0.50
Lipid-lowering drugs, n (%) 106 (82.8) 188 (87.1) 0.23

eGFR = estimated glomerular filtration rate; BMI = body mass index; CABG = coronary artery bypass grafting; PCI = percutaneous coronary intervention; ACE = angiotensin-converting enzyme; ARB = angiotensin II receptor blocker

Results: There were no significant differences in incidence of PMI between control and CKD group after 8 hours (47.6% vs 44.9%, p=0.62) or after 16 hours (64.8% vs. 61.6%, p=0.55). There were also no significant differences in intensity of PMI between control and CKD group after 8 hours (0.13 ± 0.33 vs 0.11 ± 0.21, p= 0,58)) or after 16 hours (0.24 ± 0.46 vs 0.29 ± 0.86, p=0.61). We further assessed incidence and severity of PMI with respect to CKD burden (i.e. CKD stage) and we found no significant differences in the incidence or intensity of PMI 8 and 16 h after PCI in groups according to the eGFR (Figure 1, Figure 2).

Incidence of periprocedural myocardial injury 8 h after percutaneous coronary intervention according to the estimated glomerular filtration rate.
eGFR = estimated glomerular filtration rate; PMI = periprocedural myocardial injury

Incidence of periprocedural myocardial injury 16 h after percutaneous coronary intervention according to the estimated glomerular filtration rate.
eGFR = estimated glomerular filtration rate; PMI = periprocedural myocardial injury

Conclusion: We found no association between incidence or intensity of PMI and the presence of CKD. Furthermore, CKD burden (i.e. stratification of patients according to the CKD stage) was also not associated with higher incidence or intensity of PMI after elective PCI.

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