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Chengchun Tang, Gaoliang Yan, Jiantong Hou, Xiaodong Pan, Zhongpu Chen, Chunju Yuan, Qianxing Zhou and Genshan Ma
Background:Currently, the role of angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (ARB) in CIN is paradoxical due to important differences in study design and study participant characteristics. We speculated that enalapril and folic acid tablets may have better protection on kidney target. Aim: To explore the impact of enalapril and folic acid tablet on contrast-induced nephropathy (CIN) in patients with mild renal insufficiency after percutaneous coronary intervention (PCI).
Method: A total of 816 patients undergoing selective PCI, between January 2013 and December 2016, were enrolled in a prospective cohort. Patients were divided into enalapril and folic acid tablets treatment group (n=233) (Namely, intervention group) and non ACEI/ARB treatment group (n=583) (Namely, control group). Baseline data were compared among 2 groups, and multivariate logistic regression analysis was used to analyze the independent risk factors for CIN. The clinical events within 1-month after contrast were recorded.
Result: The incidence of CIN was lower in the intervention group than in the control group (8.2% (19/233) vs. 13.4% (78/583), P=0.041). Multivariate analysis found that age odds ratio [ (OR)=1.078, P=0.001] and hypertension (OR=3.376, P=0.004), hyperhomocysteinemia (OR=3.339, P=0.001) were independent risk factors of CIN. However, eGFR was the dependent protector factor of CIN (OR=0.957, P=0.013). During 1 month follow-up, the rate of recurrent angina pectoris was lower in the intervention group than in the control group (P˂0.05), however, there were no significant differences between the 2 groups in the rates of worsening renal failure or hospitalization for worsening renal failure, dialysis/hemofiltration, acute heart failure, myocardial infarction recurrence and all-cause death (all, P˃0.05).
Conclusion: The treatment with enalapril and folic acid tablet may prevent the occurrence of CIN in patients with mild renal insufficiency after PCI.