Background
The effects of angiotensin-converting enzyme inhibitors (ACEI) on the incidence of post-cardiac catheterization contrast-induced nephropathy (CIN) are not well understood. Some studies suggest that ACEI may contribute to CIN, while others report a renoprotective effect of ACEI. We studied the effect of ACEI intake on the incidence of CIN at 72 h, at 3 months, and on the incidence of dialysis in patients undergoing coronary angiography and percutaneous coronary±intervention.
Method and results
We studied 1366 predominantly (98%) male patients, undergoing cardiac catheterization and PCI at a veterans’ administration medical center. The mean age was 68 years. Seven hundred forty-one patients (54%) were on ACEI prior to the procedure and 625 (46%) were not. CIN occurred in 25 (3%) patients in the ACEI group and in 18 patients (3%) in the non-ACEI group at 72 h after the procedure [odds ratio (OR) 1.17, 95% confidence interval (CI) 0.64–2.18; P =.6]. At 3 months, CIN was seen in 66 (9%) patients of the ACEI group vs. 41 (7%) of the non-ACEI group (OR 1.39, CI 0.93–2.08; P =.10). On multivariate analysis, after adjustment for age, co-morbidities, and baseline creatinine, ACEI therapy was not significantly associated with CIN at 72 h (OR=1.31, P =.64) or with CIN at 3 months (OR=1.21, P =.36). After a median follow-up of 65 months, 17 patients (2%) of the ACEI group were placed on dialysis vs. 19 (3%) of the non-ACEI group (hazard ratio 0.74, CI 0.39–1.45; P =.39).
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