Relationship between Arterial Lactate and Contrast-Induced Nephropathy (CIN) In Primary Percutaneous Coronary Intervention (PCI)

Background: Contrast-induced nephropathy (CIN), also called contrast-induced acute kidney injury (CI-AKI), is an indicator for renal failure, morbidity, and mortality after PCI.This affects the 13.3 million patients per year, with 1.7 million deaths.The pathogenesis includes oxidative stress, high levels of ROS, cytotoxicity, and renal hypoxia.Methods: This is a prospective observational study conducted over 18 months in a tertiary care centre in Jaipur, which has assessed the association between pre-procedural arterial lactate and CIN among STEMI patients who underwent PCI.Different criteria and techniques have been used for data collection, followed by standard procedures for statistical analysis. Results:The study was conducted among 110 patients, with males being much more predominant than females, and the age group 61 to 70 years was the most common.At baseline, CPKMB values ranged from 0.74 to 400, with a mean of 63.86±100.2,indicating high variability.Haemoglobin levels ranged from 6.8 to 16.5 g/dl (mean: 13.17±2.04),and HbA1c levels ranged from 4.2% to 11.1% (mean: 6.1±1.2%).LVEF values varied from 20% to 55% (mean: 39.77±8.66%).Post-intervention, creatinine levels slightly increased (mean: 0.914±0.331).At a lactate cut-off of 1.5 mmol/L, the sensitivity was 92%, accurately identifying 92% of CIN cases.Specificity was 62.4%, correctly identifying 62.4% of non-CIN cases. Conclusion:The study concluded that Arterial lactate levels before primary percutaneous coronary intervention (PCI) are a significant predictor of contrast-induced nephropathy (CIN).