Prevention of acute kidney injury in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention by quercetine: «case-match-control» study
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Abstract
The aim – to estimate the effect of intravenous 5-lipoxygenase inhibitor quercetine for prevention of the acute kidney injury (AKI) due to roentgen contrast media usage during percutaneous coronary interventions in patients with ST-elevation myocardial infarction (STEMI).
Material and methods. The retrospective cohort of 254 STEMI patients was studied. All the patients underwent the percutaneous coronary interventions (angiography alone, or followed by angioplastics/stenting) and had serial serum creatinine data. AKI (determined as rise in serum creatinine ≥ 44 μmol/l or ≥ 25 % rise in creatinine over baseline) was present in 40 cases (15.7 %). Then all cases were brought to the automated case-match-control pairing algorithm. Two matched groups of patients were selected: 24 pts were treated with quercetine 500 mg by intravenous infusion immediately before angiography and next 5 days – 500 mg twice daily intravenous (group 1) and 24 pts were controls (group 2). Cases were matched by 7 clinical criteria, including: age, gender, weight, prescription of drugs, which could affect serum creatinine levels (statins, ACE inhibitors, intestinal adsorbents, trimetazidine). Patients with severe congestive heart failure, nephropathy, anemia and systemic hypotension/shock at baseline were excluded.
Results. Incremental dynamics in serum creatinine level was observed in 37.5 % and 56.5 % of group 1 and group 2, respectively (mean 16.8±2.7 % vs 32.3±6.0 % of increase, respectively, Р<0.05). Rate of AKI incidence was 4.2 % in group 1 and 33.3 % in group 2 (Р<0.05). The cumulative rate of 2-10 day non-hemorrhagic adverse events was 45.8 % in group 1 and 91.7 % in group 2 (Р<0.001).
Conclusion. Our data suggest that infusion of 5-lipoxygenase inhibitor quercetine during acute phase of STEMI may prevent the development of AKI and related worsening of STEMI clinical course. This suggestion requires further investigation with larger number of patients in a prospective trial.
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