{"id":"e78ebe7c16c1","type":"article","url":"https://hartvaat.nl/2024/03/19/nierschade-na-minimale-contrasttoediening-bij-acs/","title":"Nierschade na minimale contrasttoediening bij ACS","title_en":"Kidney Injury After Minimal Radiographic Contrast Administration in Patients With Acute Coronary Syndromes.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["chronische-nierziekte"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.01.016","source_url":"https://doi.org/10.1016/j.jacc.2024.01.016","authors":["Carlo Briguori","Cristina Quintavalle","Enrica Mariano","Alessandro D'Agostino","Mario Scarpelli","Amelia Focaccio","Giuseppe Biondi Zoccai","Salvatore Evola","Giovanni Esposito","Giuseppe Massimo Sangiorgi","Gerolama Condorelli"],"significance":6,"published":"2024-03-19","source_date":"2024-03-19","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/hypertriglyceridemie/"],"congress":"","summary_en":"This study showed that even minimal contrast administration during PCI for ACS can cause kidney injury, particularly in patients with pre-existing renal impairment, informing ultra-low contrast strategies.","created":"2026-07-03T10:30:49Z","updated":"2026-07-03T13:29:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie toonde dat zelfs minimale contrasttoediening bij ACS-patiënten nierschade kan veroorzaken. Het risico is het hoogst bij pre-existente CKD en hemodynamische instabiliteit. Contrastminimalisatie blijft belangrijk.","abstract_original":"BACKGROUND: Acute kidney injury (AKI) is common in patients with acute coronary syndromes (ACS) treated by percutaneous coronary intervention. OBJECTIVES: Contrast media (CM) volume minimization has been advocated for prevention of AKI. The DyeVert CM diversion system (Osprey Medical, Inc) is designed to reduce CM volume during coronary procedures. METHODS: In this randomized, single-blind, investigator-driven clinical trial conducted in 4 Italian centers from February 4, 2020 to September 13, 2022, 550 participants with ACS were randomly assigned in a 1:1 ratio to the following: 1) the contrast volume reduction (CVR) group (n = 276), in which CM injection was handled by the CM diversion system; and 2) the control group (n = 274), in which a conventional manual or automatic injection syringe was used. The primary endpoint was the rate of AKI, defined as a serum creatinine (sCr) increase ≥0.3 mg/dL within 48 hours after CM exposure. RESULTS: There were 412 of 550 (74.5%) participants with ST-segment elevation myocardial infarction (211 of 276 [76.4%] in the CVR group and 201 of 274 [73.3%] in the control group). The CM volume was lower in the CVR group (95 ± 30 mL vs 160 ± 23 mL; P < 0.001). Seven participants (1 in the CVR group and 6 in the control group) did not have postprocedural sCr values. AKI occurred in 44 of 275 (16%) participants in the CVR group and in 65 of 268 (24.3%) participants in the control group (relative risk: 0.66; 95% CI: 0.47-0.93; P = 0.018). CONCLUSIONS: CM volume reduction obtained using the CM diversion system is effective for prevention of AKI in patients with ACS undergoing invasive procedures. (REnal Insufficiency Following Contrast MEDIA Administration TriaL IV [REMEDIALIV]: NCT04714736)."}