Incidence, Risk Factors, and In-Hospital Mortality of Contrast-Induced Nephropathy in Field Triaged Patients with Acute Myocardial Infarction

Introduction: Launceston General Hospital (LGH) is a regional/rural centre for primary PCI and does not have onsite cardiac surgery. In order to assess the quality of care, in the management of acute ST elevationmyocardial infarction (STEMI) patients, undergoing primary PCI, an audit was performed at the LGH. Methods:A reviewwas undertaken of all patients taken to the cardiac catheterization lab for primary PCI between January 2007 and December 2009. Patients transferred to LGH following thrombolysis from an outside hospital were excluded. Thrombolysiswithin the LGHwasnot performed and thus this represents a consecutive cohort of STEMI patients. Results: 272 patientswith acute STEMIhadprimary PCI performed. Culprit vessels were the right coronary artery in 40%, left anterior descending 34%, circumflex in 12% and branch disease in the remaining. Fifty two percent of the patients had multivessel disease and 2 patients had previous coronary arterybypass graft (CABG). Tenpercent of patients had ejection fraction <30% in the acute setting. Intravenous glycoprotein IIb/IIIa agents were used in 39%. There was an average of 1.3 stents/patient with a baremetal stent used 86% of cases and drug eluting stents in 14%. Revascularization was accomplished in all cases with a minimum of TIMI 2 flow. A total of 4 (1.3%) patients died during the hospital stay. Three patients required blood transfusions and one patient had a groin infection. No other serious complication was noted. No patients were transferred for emergency CABG. Conclusion: In this real world setting at a regional/rural PCI centre, in hospital complication rates for primary PCI were low and in keeping with worldwide standards.