Publication: Prevalencia y pronóstico de la nefropatía tras intervencionismo coronario percutáneo de pacientes con síndrome coronario agudo y función renal normal
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2017-08-22
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Universidad Complutense de Madrid
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Abstract
El incremento de la creatinina plasmática tras una intervención coronaria percutánea no es infrecuente y se ha asociado a un pronóstico adverso. Además, el desarrollo de nefropatía tras el intervencionismo coronario percutáneo se asocia a un importante aumento de la morbi-mortalidad (mortalidad intrahospitalaria en torno al 20%) y a un incremento de la estancia y de los costes hospitalarios. Las causas de insuficiencia renal aguda tras un procedimiento de revascularización coronaria percutánea son muy variadas, e incluyen nefrotoxicidad por el contraste, alteraciones hemodinámicas, toxicidad farmacológica o ateroembolia. El grado de insuficiencia renal preexistente es el mayor factor de riesgo para el desarrollo de nefropatía post-intervencionismo coronario y por lo tanto las medidas nefroprotectoras se focalizan en este subgrupo de pacientes. Sin embargo, los pacientes con síndrome coronario agudo tratados mediante revascularización percutánea pueden constituir también una población con un mayor riesgo de nefropatía post-intervencionismo coronario percutáneo. El mejor tratamiento de esta grave complicación es la prevención. En las guías actuales de la Sociedad Europea de Cardiología para el manejo de pacientes con síndrome coronario agudo sin elevación persistente del segmento ST solo se recomiendan medidas nefroprotectoras en pacientes con síndrome coronario agudo e insuficiencia renal crónica, por lo que la realización de estudios en los pacientes con función renal normal podría identificar un subgrupo de los mismos que también se beneficien de estas medidas preventivas...
"Introduction and objectives" Increased plasmatic levels of creatinine following percutaneous coronary intervention are not uncommon and have been associated with adverse prognoses. The development of percutaneous coronary intervention-associated nephropathy is associated with a substantial increase in morbidity and mortality (hospital mortality of around 20%), prolonged hospital stays, and higher hospital costs. There are many causes of acute kidney injury following percutaneous coronary revascularization procedure, including: contrast-induced nephrotoxicity, hemodynamic alterations, drug-induced toxicity and atheroembolism. The most important risk factor for developing percutaneous coronary intervention-associated nephropathy is the degree of preexisting renal disease; therefore, nephroprotective measures are usually taken into consideration in this patient subgroup. Nonetheless, patients with acute coronary syndrome that undergo percutaneous coronary intervention are also at a higher risk of developing subsequent nephropathy. The optimal management of this serious complication is prevention; however, the current guidelines of the European Society of Cardiology for the management of patients with acute coronary syndrome without persistent ST-segment elevation only recommend nephroprotective measures in patients with acute coronary syndrome and chronic kidney disease. Therefore, studies including patients with normal renal function could help identify a subgroup of patients who would also benefit from these preventative measures...
"Introduction and objectives" Increased plasmatic levels of creatinine following percutaneous coronary intervention are not uncommon and have been associated with adverse prognoses. The development of percutaneous coronary intervention-associated nephropathy is associated with a substantial increase in morbidity and mortality (hospital mortality of around 20%), prolonged hospital stays, and higher hospital costs. There are many causes of acute kidney injury following percutaneous coronary revascularization procedure, including: contrast-induced nephrotoxicity, hemodynamic alterations, drug-induced toxicity and atheroembolism. The most important risk factor for developing percutaneous coronary intervention-associated nephropathy is the degree of preexisting renal disease; therefore, nephroprotective measures are usually taken into consideration in this patient subgroup. Nonetheless, patients with acute coronary syndrome that undergo percutaneous coronary intervention are also at a higher risk of developing subsequent nephropathy. The optimal management of this serious complication is prevention; however, the current guidelines of the European Society of Cardiology for the management of patients with acute coronary syndrome without persistent ST-segment elevation only recommend nephroprotective measures in patients with acute coronary syndrome and chronic kidney disease. Therefore, studies including patients with normal renal function could help identify a subgroup of patients who would also benefit from these preventative measures...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 18-01-2016