Iranian Heart Journal

Iranian Heart Journal

Elevated Arterial Lactate as a Predictor of Contrast-Induced Nephropathy following Percutaneous Coronary Intervention

Document Type : Original Article

Authors
Mahmoud Baraka
Ahmed Shawky Elserafy
Ahmed Shokry
Ahmed Elshazly
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Abstract
Background: The incidence of contrast-induced nephropathy (CIN) varies from 0% to 24%. Its mechanism is multifactorial and still not yet fully understood.
In our study, we aimed to evaluate the role of elevated arterial lactate as a predictor of CIN following percutaneous coronary intervention (PCI) in diabetic patients with acute coronary syndrome (ACS).
 
Methods: This prospective study enrolled 200 diabetic patients with ACS who underwent PCI. Patients with hemodynamic instability, renal impairment, or recent contrast exposure were excluded. Arterial lactate was measured on admission and serum creatinine at 0 and 72 hours. CIN was defined as a rise in serum creatinine of at least 0.5 mg/dL or a 25% increase from baseline within 48–72 hours after contrast exposure.
 
Results: The mean age was 60 ± 10.34 years, 64% were males, and 33% developed CIN (n = 66). Higher arterial lactate was directly proportional to CIN development (P < 0.001). Other predictors were the heart failure signs, procedure duration, and contrast volume >100 mL. In multivariate regression, the most significant predictors were preprocedural arterial lactate > 1 mmol/L (OR 3.932, 95% CI 1.765 to 8.759; P = 0.001) and procedure duration > 69 minutes (OR 4.180, 95% CI 1.884 to 9.272; P < 0.001).
 
Conclusions: Preprocedural arterial lactate >1 mmol/L, and procedure duration > 69 minutes were the most important predictors of CIN in diabetic patients with ACS who underwent PCI. Other risk factors were heart failure signs and contrast volume > 100 mL. (Iranian Heart Journal 2025; 26(2): 23-32)
Keywords
Contrast-induced nephropathy
Arterial lactate
Percutaneous coronary intervention
Acute coronary syndrome
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Iranian Heart Journal
Volume 26, Issue 2
Spring 2025
Pages 23-32