Multivessel Revascularization Does Not Increase Contrast-Induced Acute Kidney Injury Incidence in Acute Myocardial Infarction: A Meta-Analysis

Abstract

Background: Recent studies and meta-analysis have shown that complete revascularization (CR) compared with infarct-related artery revascularization (IRA) during percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) is associated with decreased mortality. However, it is unclear if CR versus IRA in STEMI during indexed hospitalization is associated with risk of contrast-induced acute kidney injury (CI-AKI).

Methods: A database search was conducted for all randomized controlled trials that enrolled STEMI patients and compared CR versus IRA and reported CI-AKI. Comprehensive Meta-Analysis Version 2.0 (Wiley, Chichester) was used to determine summary effect size with a fixed-effect model and expressed as a risk ratio with 95 % confidence intervals.

Results: A total of four trials were identified and had a mean follow-up of 24.5 ± 9.9 months, a total sample size of 1537, a mean age of 63.8 ± 1.2 versus 64.2 ± 2.1 years, 31.2 ± 5.3 versus 30.1 ± 4.7 % three-vessel disease, and 33.7 ± 4.1 versus 37.2 ± 4.5 % anterior STEMI in the CR versus IRA groups, respectively. A total of 276.7 ± 25.2 versus 186.7 ± 15.3 mL contrast was used in the CR versus IRA respectively (p = 0.006). There were no statistical significant differences between the two groups in the reported incidence of CI-AKI (1.3 % CR vs. 1.9 % IRA; p = 0.4), major bleeding (1.7 % CR vs. 2.5 % IRA; p = 0.4) and stroke (1.1 % CR vs. 0.4 % IRA; p = 0.24). However, there was a significantly increased incidence of cardiovascular death (2.0 % CR vs. 4.7 % IRA; p = 0.01) and ischemia-driven revascularization (6.2 % CR vs. 18.3 % IRA; p < 0.01).

Conclusion: In the index hospitalization, CR in STEMI patients is associated with significant risk reduction in cardiac death and revascularization and a non-significant reduced trend of CI-AKI, despite increased use of contrast when compared with IRA.