Efficacy of Coronary Sinus Aspiration in Reducing Contrast-Induced Nephropathy in High-Risk Patients

Abstract

Background: Contrast-induced nephropathy (CIN) is a complication of angiographic procedures. Coronary sinus aspiration (CSA) is a novel technique aimed at reducing renal exposure to contrast and mitigating the risk of CIN.

Objectives: The aim of the study was to evaluate the rates of CIN in high-risk patients with and without CSA at the time of coronary angioplasty.

Methods: In this single-center, prospective, single-blind randomized controlled trial, 70 high-risk patients undergoing coronary angioplasty were randomized into 2 groups: the intervention group (coronary angioplasty with CSA) and the control group (coronary angioplasty). The primary outcome was the proportion of patients developing CIN (defined as an increase in serum creatinine of at least 25% or 0.5 mg/dL within 3 days following the procedure).

Results: In total, 70 patients with diabetes and chronic kidney disease 3 (mean age 60.6 ± 8.7 years) were included. Of the 37 participants initially allocated to CSA, 4 were excluded (3 due to difficulties in coronary sinus cannulation and 1 due to a procedural complication). The mean volume of injected contrast was 65.2 ± 23 mL and the estimated volume of aspirated contrast was 18.7 ± 7.1 mL. Among the 66 remaining patients, the rate of CIN was lower in the intervention group (5/33, 15.2%) compared to the control group (13/33, 39.4%) (P = 0.027). There were no differences in postprocedural serum creatinine and estimated glomerular filtration rate.

Conclusions: While CSA was associated with lower rates of CIN in high-risk patients undergoing coronary angioplasty, procedural complications can occur. Larger studies are needed to understand the role of CSA for high-risk patients undergoing coronary angioplasty.

Keywords: contrast-induced acute kidney injury; coronary angioplasty; coronary sinus aspiration technique.