Abstract | BACKGROUND: METHODS: We randomly assigned 208 patients with moderate renal insufficiency ( creatinine ≥ 1.7mg/dL within 3 months and/or documented creatinine ≥ 1.5mg/dL within 1 week before cardiac catheterization) to hold ACEI/ARB ≥24 hours preprocedure or continue ACEI/ARB. The primary outcome was the incidence of AKI defined as an absolute rise in serum creatinine of ≥0.5mg/dL from baseline and/or a relative rise in serum creatinine of ≥25% compared with baseline measured at 48 to 96 hours postcardiac catheterization. RESULTS: All patients were taking an ACEI (72.1%) or ARB (27.9%) prior to randomization. At 48 to 96 hours, the primary outcome occurred in 18.4% of patients who continued ACEI/ARB compared with 10.9% of the patients who held ACEI/ARB (hazard ratio 0.59, 95% CI 0.30-1.19, P = .16). In a prespecified secondary outcome, there was a lower rise in mean serum creatinine after the procedure in patients who held ACEI/ARB (0.3 ± 0.5 vs 0.1 ± 0.3mg/dL, P = .03). The clinical composite of death, myocardial infarction, ischemic stroke, congestive heart failure, rehospitalization for cardiovascular cause, or need for dialysis preprocedure occurred in 3.9% who continued ACEI/ARB compared with 0% who held the ACEI/ARB (hazard ratio 0.11, 95% CI 0.01-2.96, P = .06). CONCLUSION: In this pilot study of patients with moderate renal insufficiency undergoing cardiac catheterization, with-holding ACEI/ARB resulted in a non-significant reduction in contrast-induced AKI and a significant reduction in post-procedural rise of creatinine. This low cost intervention could be considered when referring a patient for cardiac catheterization.
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Authors | Kevin R Bainey, Sherali Rahim, Krystal Etherington, Michael L Rokoss, Madhu K Natarajan, James L Velianou, Sonya Brons, Shamir R Mehta, CAPTAIN Investigators |
Journal | American heart journal
(Am Heart J)
Vol. 170
Issue 1
Pg. 110-6
(Jul 2015)
ISSN: 1097-6744 [Electronic] United States |
PMID | 26093871
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
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Copyright | Copyright © 2015 Elsevier Inc. All rights reserved. |
Chemical References |
- Angiotensin Receptor Antagonists
- Angiotensin-Converting Enzyme Inhibitors
- Contrast Media
- Creatinine
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Topics |
- Acute Kidney Injury
(blood, chemically induced, prevention & control)
- Aged
- Aged, 80 and over
- Angiotensin Receptor Antagonists
(therapeutic use)
- Angiotensin-Converting Enzyme Inhibitors
(therapeutic use)
- Cardiac Catheterization
(methods)
- Contrast Media
(adverse effects)
- Coronary Angiography
(methods)
- Coronary Artery Disease
(complications, diagnosis)
- Creatinine
(blood)
- Female
- Humans
- Male
- Middle Aged
- Percutaneous Coronary Intervention
(methods)
- Pilot Projects
- Preoperative Care
(methods)
- Renal Insufficiency, Chronic
(blood, complications)
- Single-Blind Method
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