Impact of routine cardiovascular medications on contrast induced nephropathy post percutaneous coronary intervention: a national experience
A Rahhal, O Alameen, A Mahfouz, S Alyafei, A Arabi, Khaled MohamedAbstract
Background
The impact of routinely prescribed cardiovascular (CV) medications on the development of contrast-induced nephropathy (CIN) post percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) remains insufficiently explored, especially with the emerging therapies such as sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor–neprilysin inhibitors (ARNi).
Purpose
To evaluate the association between commonly used CV medications and the risk of CIN.
Methods
We conducted a case-control study that included all patients who underwent revascularization with PCI at the main tertiary cardiology center in Qatar between 2016-2023. The use of routine CV medications, including P2Y12 inhibitors (clopidogrel, ticagrelor), high-intensity statin (atorvastatin, rosuvastatin), Angiotensin-Converting Enzyme Inhibitors/ Angiotensin Receptor Blockers/ ARNi (ACEi/ARB/ARNi), and loop diuretics, was defined as the established use before PCI or early initiation within 24 hours of contrast exposure. Cases were patients who developed CIN defined as an increase in serum creatinine by more than 0.3mg/dL or more than 50% of the baseline value within 48-72 hours of contrast exposure, while controls were patients without CIN. The primary outcome was the risk of CIN with the routine CV medications use. Multivariable logistic regression analysis was used with P-value <0.05 indicating statistical significance.
Results
We included 16463 patients who met the eligibility criteria (91% male, mean age 52±11 years). Clopidogrel was used in 98% of patients, while atorvastatin 40 mg was the predominant statin prescribed. CIN occurred in 2.5% of the study population. Using multivariable logistic regression, diuretic use was the strongest predictor of CIN (OR 10.39, 95% CI 8.38–12.87; p<0.001). SGLT2 inhibitor therapy was associated with increased odds of CIN (OR 1.43, 95% CI 1.02–2.00; p=0.038), whereas ACEi/ARB/ARNi use was independently associated with lower odds (OR 0.69, 95% CI 0.55–0.86; p<0.001). No significant associations were observed for P2Y12 inhibitors or statins.
Conclusion
The use of CV medications peri-PCI, including diuretics and SGLT2 inhibitors was associated with increased CIN risk, while ACEi/ARB/ARNi use lowered the risk of CIN, suggesting a potential protective effect. Our findings highlight the importance of medication-related risk stratification in patients undergoing PCI and warrant further prospective validation.