Contrast volume and in-hospital outcomes of dialysis patients undergoing percutaneous coronary intervention

www.nature.com/scientificreports OPEN Contrast volume and in‑hospital outcomes of dialysis patients undergoing percutaneous coronary intervention Toshiki Kuno1*, Yohei Numasawa2, Satoshi Shoji3, Ikuko Ueda3, Masahiro Suzuki4, Shigetaka Noma5, Keiichi Fukuda3 & Shun Kohsaka3 Toxicity resulting from retained contrast media may cause adverse cardiovascular outcomes (e.g., heart failure and cardiogenic shock) for dialysis patients. However, the association between the administered contrast volume and outcomes of dialysis patients after percutaneous coronary intervention (PCI) has not been sufficiently investigated. We evaluated 953 consecutive dialysis patients (age, 67.9 ± 9.9 years; 30.1% with acute coronary syndrome) who underwent PCI between September 2008 and March 2019. Patients were divided into two groups: those with a contrast volume ≥ 200 ml and those with a contrast volume < 200 ml. The cutoff was 200 ml because 100 ml increment of contrast volume is known to raise the risk of acute kidney injury, and 200 ml is more than the average volume used at most PCI centers. The primary endpoint was a composite of in-hospital death, post-PCI cardiogenic shock and post-PCI heart failure. A multivariable logistic regression model and smooth spline curve were constructed to assess the association between contrast volume and the primary endpoint. The median contrast volume was 157 ml (interquartile range, 115–210 ml). The overall primary endpoint incidence was 6.8% (N = 65). A contrast volume ≥ 200 ml was associated with a higher risk of the primary endpoint (odds ratio 2.91; 95% confidence interval 1.42–6.05; P = 0.004). The smooth spline curve demonstrated a linear relationship between the contrast volume and primary endpoint. In conclusions, the contrast volume was associated with adverse in-hospital outcomes of dialysis patients undergoing PCI. Attention should be focused on the contrast volume used for dialysis patients undergoing PCI. Abbreviations ACS Acute coronary syndrome AKI Acute kidney injury JCD-KiCS Japan Cardiovascular Database-Keio Interhospital Cardiovascular Studies PCI Percutaneous coronary intervention STEMI ST-segment elevation myocardial infarction The contrast volume administered to patients undergoing percutaneous coronary intervention (PCI) is strongly associated with the risk of acute kidney injury (AKI)1–4. Clinical practice guidelines recommend minimizing the contrast volume to the lowest feasible level, especially for patients who are at high risk for A KI3. However, these recommendations are largely limited to non-dialysis patients. Several studies of dialysis patients have demonstrated that PCI operators focus little attention on the contrast volume because the contrast medium is cleared by subsequent dialysis2,5,6. The association between the contrast volume and adverse outcomes other than AKI (e.g., heart failure and cardiogenic shock) for dialysis patients has been insufficiently investigated. A higher contrast volume is typically needed for PCI procedures performed for dialysis patients because of the higher incidence of complex coronary 1 Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210Th St, New York, NY 10467‑2401, USA. 2Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan. 3Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. 4Department of Cardiology, Saitama National Hospital, Wako, Japan. 5Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan. *email: Scientific Reports | (2022) 12:17718 | https://doi.org/10.1038/s41598-022-21815-y 1 Vol.:(0123456789) www.nature.com/scientificreports/ lesions; therefore, cardiac toxicity caused by higher concentrations of contrast media reaching the coronary arteries is a c oncern7,8. Additionally, acute expansion of plasma volume caused by osmotic effects may lead to heart failure. We hypothesized that cardiovascular toxicity caused by the retained contrast media could result in adverse events, including new-onset cardiogenic shock and heart failure after PCI7. Using the contemporary multicenter all-comer PCI registry, we investigated the association between contrast volume and the risk of adverse inhospital outcomes of dialysis patients undergoing PCI. Methods Database. This study was conducted as part of the Japan Cardiovascular Database-Keio Interhospital Car- diovascular Studies (JCD-KiCS) PCI registry, which is a multicenter, prospective registry including data of consecutive patients who underwent PCI between 2009 and 2017 at 15 institutions within the Tokyo metropolitan area. It primarily includes large tertiary care referral centers (≥ 200 beds; n = 13) and a few medium-sized satellite hospitals (< 200 beds; n = 2). The details of this registry have been published p reviously2,9–13. The participating hospitals were instructed to document and register patient data of consecutive hospital visits for PCI using an internet-based data collection system. Registered data were reviewed for completeness and internal consistency. Quality assurance of the data was achieved through automatic system validation, reporting of data completeness, and education and training of clinical research coordinators who were specifically trained to use the present PCI registry. The senior study coordinator (I.U.) and exclusive on-site auditing by the investigator (S.K.) ensured appropriate registration of each patient. All participants provided written informed consent. Before the launch of the JCD-KiCS registry, information regarding the objective of this registry was provided for clinical trial registration in the University Hospital Medical Information Network of Japan (UMIN000004736). The present study was approved by the institutional review board Committee of Keio University (Reference Number: 20080073), and was conducted in accordance with the principles of the Declaration of Helsinki. We also confirmed that all methods were performed in accordance with relevant guidelines and regulations. Definition of outcomes and variables. The clinical variables and outcomes of the JCD-KiCS were aligned with the data of the National Cardiovascular Data Registry CathPCI Registry version 4.1. Acute coronary syndrome (ACS) was defined as ST-segment elevation myocardial infarction (STEMI), non-STEMI, unstable angina. Stable coronary artery disease was defined as stable angina, previous myocardial infarction, and silent ischemia. The presence of heart failure was defined as documentation of heart failure by the attending physician, regardless of left ventricular ejection fraction. Multivessel disease was defined as two or more major coronary arteries with ≥ 75% stenosis. The estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease Equation for Japanese Patients proposed by the Japanese Society of N ephrology14–16. All major procedural complicat (...truncated)