What is the role of left ventricular end-diastolic pressure (LVEDP)-guided hydration in percutaneous coronary intervention (PCI)?

Updated: Nov 27, 2019
  • Author: George A Stouffer, III, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

In patients undergoing coronary angiography or PCI, the use of sliding-scale hydration guided by left ventricular end-diastolic pressure (LVEDP) reduces not only the risk of contrast nephropathy but also the risk of clinical events at 6 months. [81]

In the POSEIDON (Prevention of Contrast Renal Injury with Different Hydration Strategies) trial, patients treated with the LVEDP-guided hydration and conventional-hydration strategies were given 3 mL/kg of 0.9% saline over the course of an hour before the procedure. [81] During the procedure, patients in the standard arm received 1.5 mL/kg/hr, whereas patients in the LVEDP-guided arm received 5 mL/kg/hr if the LVEDP was below 13 mm Hg, 3 mL/kg/hr if the LVEDP was 13-18 mm Hg, and 1.5 mL/kg/hr if the LVEDP was above 18 mm Hg.

The use of sliding-scale hydration reduced the primary endpoint (defined as a 25% or 0.5-mg/dL increase in serum creatinine levels) by 59%. [81] At 6-months’ follow-up, LVEDP-guided treatment significantly reduced the composite endpoint of death, MI, and dialysis by 68%.

On the basis of several studies, the most widely recommended hydration regimen is isotonic crystalloid (1.0-1.5 mL/kg/hr) for 3-12 hours before the procedure and 6-24 hours after the procedure.

Earlier studies on N-acetyl-L-cysteine produced conflicting results; however, ACT (Acetylcysteine for Contrast-Induced Nephropathy Trial) study data on 2308 randomly assigned patients demonstrated no benefit with respect to reducing the incidence of contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients. [82]


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