Acute Kidney Injury After Percutaneous Coronary Intervention Guided by Intravascular Ultrasound

Abstract

Purpose We investigated the impact of intravascular ultrasound guidance on reducing the incidence of contrast-induced acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary intervention (PCI). Methods Ninety-nine patients were enrolled in this prospective cohort who were not randomly assigned to angiography-guided percutaneous coronary intervention or intravascular ultrasound-guided percutaneous coronary intervention. The patients were hospitalized at the Vietnam National Heart Institute - Bach Mai Hospital between 2019 and 2020. Acute kidney injury incidence during hospitalization was the primary endpoint. Results A total of 99 patients were divided into two groups: the intravascular ultrasound-guided group (33 participants) and the angiography-guided group (66 participants). The mean ± SD contrast volume of each group was 95.2 ± 37.1 mL and 133.0 ± 36.0 mL for the ultrasound-guided and angiography-guided groups, with P < 0.0001. Intravascular imaging-guided percutaneous coronary intervention (IVUS-guided PCI) was associated with reduced acute kidney injury incidence during hospitalization: 0.0% vs. 12.12% and P = 0.049. Conclusions Intravascular ultrasound is a safe imaging tool that guides percutaneous coronary intervention and significantly reduces the rate of acute kidney injury compared to angiography alone. Patients who have a high chance of experiencing acute kidney injury benefit from using intravascular ultrasound.

Keywords: contrast-induced acute kidney injury; intravascular ultrasound (ivus); iodinated contrast; ivus-guided pci; primary percutaneous coronary intervention (pci).

Figure 1. Total contrast volume

SD: standard deviation; **Student’s t-test (comparison of means). P ≤ 0.05 is regarded as significant.

Figure 2. Contrast volume/eGFR ratio

SD: standard deviation; **Student’s t-test (comparison of means). P ≤ 0.05 is regarded as significant.