Abstract 286: Inverse Relationship Between Body Mass Index And Glomerular Filtration Rate Following Contrast Media Administration In Patients With Primary Percutaneous Coronary Intervention

Background: Renal dysfunction following contrast (CM) media administration carries poor prognosis and less predictable in patients undergoing Primary percutaneous Coronary Intervention (PPCI). Although obesity is a known risk factor for renal failure, its prognostic significance in renal dysfunction following CM administration in the setting of PPCI is less explored. Therefore we sought to investigate the relationship between obesity as measured by body mass index (BMI) and renal function after CM administration during PPCI. Methods: Cohort consisted 113 patients at our institution who underwent PPCI from 01/2009 to 11/2012 as per evidence based guidelines. Obesity was defined as BMI ≥30 kg/m2. Patients with hemodynamic instability (intra aortic balloon pump use) and end stage renal failure (GFR<15 mL/min/m2 or on chronic dialysis) were excluded. Glomerular filtration rates (GFR) at baseline, at 24 hours post PPCI and before hospital discharge were calculated with modified diet in renal disease (MDRD) equation. The relationship between BMI and GFR was assessed in stepwise multiple linear regression analysis (MLRA) Results: Cohort dominated by PPCI performed for ST segment elevation myocardial infarction (STEMI) (104; 92%), African American race (70; 61%) and male gender (77; 68%). When compared to non obese [median BMI (IQR) = 25 (23.2-28.1) kg/m2], obese [median BMI (IQR) = 33.5 (31.9-35.7) kg/m2] had greater proportion of patients with dyslipidemia [30% (16) vs. 51% (25); P=0.026]. Other covariates were similarly distributed between both groups. BMI was negatively correlated with GFR 24 hours post PPCI (r= -0.206; P=0.043) and GFR prior to hospital discharge (r= -0.209; P=0.038) (Graph 1). MLRA adjusted for factors known to influence renal function showed that BMI was negatively associated with GFR prior to hospital discharge: r square =0.427;β=- 2.98; t= - 2.98 P=0.005. (Table 1) Conclusions: BMI increase is independently associated with GFR decline following CM administration in patients with PPCI. Clinical guidelines at present do not account for BMI during CM administration. These data suggest the need for CM dose adjustment according to individual’s BMI. Further studies are needed.