Intravascular Volume Expansion Before Primary Angioplasty for Prevention of Acute Kidney Injury Hydration or Dilution

摘要: In this issue of Circulation: Cardiovascular Interventions , Maioli and colleagues, from Florence, Italy, report the results a 450-patient, prospective, randomized trial patients with ST-elevation–myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).1 Patients STEMI are at high risk development contrast-induced acute kidney injury (CI-AKI). Accordingly, authors randomly assigned into 1 3 groups: early hydration bolus sodium bicarbonate started in emergency room followed by 12-hour infusion; postprocedural normal saline drip after PCI; last, no specific protocol. enrolled were fairly typical those presenting STEMI, mean age mid-60s; almost quarter over 75 years age, majority male. Slightly more than 22% diabetic, about 40% presented anterior myocardial infarction, had an ejection fraction <0.40. The incidence shock was 5%, but intra-aortic balloon pumps used liberally 20% cases. More estimated glomerular filtration rate (eGFR) ≤60 mL/min. Although door-to-balloon time 85 minutes could be criticized, such values not unusual mid-2000s, when study performed. Overall, clinical outcomes acceptable, 16 deaths, 6 strokes, cumulative number adverse cardiac events 45 (10%). main finding significantly lower CI-AKI, matter which definition used, among to group. Article see p 456 A points regarding important bear emphasis. First, particularly as evidenced 27% CI-AKI observed control group trial. Operators …