Preventive Effect of the PRetreatment With pItavastatiN on Contrast-Induced Nephropathy in Patients With RenaL Dysfunction UndErgoing Coronary Angiography/Intervention (PRINCIPLE-II Study)
Overview
- Phase
- Phase 4
- Intervention
- Pitavastatin
- Conditions
- Contrast-induced Nephropathy
- Sponsor
- Gachon University Gil Medical Center
- Enrollment
- 404
- Locations
- 1
- Primary Endpoint
- Incidence of contrast-induced nephropathy
- Last Updated
- 12 years ago
Overview
Brief Summary
Contrast-induced nephropathy (CIN) is a well-recognized complication of radiographic contrast administration and is associated with increased short- and long-term mortality. Previous strategies including forced diuresis with diuretics or mannitol, intravenous administration of fenoldopam or dobutamine, and postprocedure hemodialysis to prevent CIN have been largely unsuccessful. In addition, the use of N-acetylcysteine to prevent CIN has yielded conflicting outcomes.
A review of a large insurance database and retrospective study have shown that statins therapy is associated with a lower incidence of CIN after percutaneous coronary intervention. The preventive effect of statins on CIN may be attributed to direct pleiotropic effects on the vascular wall such as improvement of endothelial dysfunction, anti-inflammatory or anti-oxidative effect. However, recent randomized trial could not demonstrate the preventive effect of statin on CIN in patients with chronic kidney disease.
Thus, we will investigate the preventive effect of pitavastatin on CIN in patient with renal dysfunction undergoing coronary angiography or intervention.
Investigators
Woong Chol Kang
Associate Professor
Gachon University Gil Medical Center
Eligibility Criteria
Inclusion Criteria
- •Age ≥ 19 years
- •Need for coronary angiography or intervention in patients with typical symptoms for angina or myocardial infarction, or documented myocardial ischemia at non-invasive studies including ECG, treadmill ECG test, heart spect or coronary CT angiography
- •Estimated glomerular filtration rate ≤60 mL/min
- •Informed consent
Exclusion Criteria
- •Need for primary percutaneous coronary intervention or emergent intervention in patients with myocardial infarction
- •Allergic reaction for contrast agent (Visipaque) or statin
- •Contraindication for contrast agent (Visipaque) or statin
- •Shock status fron any cause including cardiogenic shock
- •Statin use before enrollment (Enrollment after 2 weeks of wash-out period)
- •Exposure of contrast agent within 7 days before enrollment
- •Pregnancy or Expectation for pregnancy in women of childbearing age
- •Heart failure (NYHA class ≥3 or left ventricular ejection fraction \< 40%)
- •Acute renal injury
- •Dialysis therapy
Arms & Interventions
Pitavastatin
Pitavastatin 4 mg/day for 7 days before coronary angiography/intervention
Intervention: Pitavastatin
Placebo
Placebo tablet for 7 days before coronary angiography/intervention
Intervention: Placebo
Outcomes
Primary Outcomes
Incidence of contrast-induced nephropathy
Time Frame: 48 hours
Contrast-induced nephropathy is defined as either a greater than 25% increase of serum creatinine or an absolute increase in serum creatinine of 0.5 mg/dL after coronary angiography or intervention.
Secondary Outcomes
- Length of hospital stay(an expected average of 5 weeks)
- Peak level of serum creatinine(48 hours)
- serum cystatin-C level(24 hours)
- serum neutrophil-gelatinase-associated lipocalin(NGAL) level(4 hours)
- Clinical events(1 month)