The role of Trimetazidine in the Prevention of Contrast-Induced Nephropathy After Coronary Angiography Procedures

Abstract

C ontrast induced nephropathy (CIN) is defined as is most commonly defined as a 25% increase in serum creatinine from basal level or an absolute increase of at least 0.5 mg/dL that occurs within 48 hours after contrast administration and persisting for two to five days. The reported incidence of CIN following percutaneous coronary intervention lies between 0 and 24%. This depends on the associated risk factors, with the greatest incidence being reported after emergency PCI. Patients who develop CIN have greater complications, a worse prognosis, more serious long-term outcomes, and longer duration of hospital stay. Hospital mortality rates in such patients have been reported as 36% and the two-year survival rate as only 19%. Following PCI, CIN is linked to higher incidence of cardiogenic shock, pulmonary edema and need for target vessel revascularization after one year. The pathophysiology of CIN encompasses multiple interacting mechanisms. They include induced vasospasm of the renal vessels where the medulla is already relatively hypoxic, direct cytotoxic effects on renal cells and indirect damage through the generation of oxygen free radicals. The most reliable method for the prevention of CIN is through adequate pre-procedural hydration. Other proposed methods include the use of statins, acetylcysteine, sodium bicarbonate infusion, ascorbic acid and allopurinol. Trimetazidine is a metabolic anti-ischemic drug which is proposed to be beneficial in reducing the incidence of CIN. The aim of the work is to evaluate the role of trimetazidine in reducing the incidence of CIN following contrast media injection. This study was conducted on one hundred patients presented to Ain Shams university hospitals having a basal creatinine clearance below 90 ml/min and opting for coronary angiography procedures within the period between August 2015 and June 2016. The patients were divided into two equal groups each including fifty patients where both groups received parenteral hydration in the form of isotonic saline at a rate of 1 mg/kg body weight per hour starting 12 hours before angiography and up to 12 hours thereafter. In Group 1, patients received additional medication in the form of trimetazidine 35 mg twice daily for 72 hours and starting 48 hours before the procedure which was not received in group 2 (control).