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Post-PCI Contrast Nephropathy

Mehran Score

Predicts risk of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI).

Hypotension: SBP <80 for ≥1 hr requiring inotrope or balloon pump within 24 hrs of cath
Intra-aortic balloon pump
Congestive heart failure: CHF class III/IV by NYHA ano/or pulmonary edema
Age > 75 year
Anemia: Baseline Hct <39% for men and Hct < 36% for women
Diabetes
eGFR (ml/min/1.73 m2)

LVEDP guided hydration protocol

Pre-procedure:  

During procedure:

Post procedure:

(3 ml/kg x 1 h)

LVEDP

(mmHg)

Rate

(ml/h)

< 13

13-18

> 18

(5 ml/kg/h)

(3 ml/kg/h)

(1.5 ml/kg/h)

Continued x 4 h

Reduce the risk of CIN

  • Before the procedure, assess the risk of contrast-induced nephropathy. 
  • Provide sufficient hydration before the procedure. 
  • Keep track of the amount of contrast media used and minimize its use. 
  • Consider using high-intensity statins before the procedure. 
  • If possible, use the radial artery. 
  • Avoid giving prophylactic renal replacement therapy. If possible, delay CABG in stable patients for more than 24 hours after angiography.

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References

1. Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. Journal of the American College of Cardiology. 2004 Oct 6;44(7):1393–9.​

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2. Brar SS, Aharonian V, Mansukhani P, et al. Haemodynamic-Guided Fluid Administration for the Prevention of Contrast-Induced Acute Kidney Injury: The POSEIDON Randomised Controlled Trial. Lancet 2014;383:1814-23.

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3. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS Jr, Nnacheta LC, Rao SV, Sabik JF, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021;00:000-000.

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