Post-contrast acute kidney injury (PC-AKI) is a severe complication of coronary angiography (CAG) and percutaneous coronary intervention (PCI). Currently, the effect of statins on PC-AKI and its mechanism remains unclear. This multicenter retrospective observational study included 4386 patients who underwent CAG or PCI from December 2006 to December 2019 in Sir Run Run Shaw Hospital and its medical consortium hospitals. Serum creatinine pre- or post-procedure within 72 h after PCI was recorded. Multivariate logical regression was used to explore whether preoperative use of statins was protective from PC-AKI. The path analysis model was then utilized to look for the mediation factors of statins. Four thousand three hundred eighty-six patients were enrolled totally. The median age of the study population was 68 years old, 17.9% with PC-AKI, and 83.3% on preoperative statins therapy. The incidence of PC-AKI was significantly lower in group of patients on statins therapy. Multivariate regression indicated that preoperative statins therapy was significantly associated with lower percentage of elevated creatinine (β: -0.118, P < 0.001) and less PC-AKI (OR: 0.575, P < 0.001). In the preoperative statins therapy group, no statistically significant difference was detected between the atorvastatin and rosuvastatin groups (OR: 1.052, P = 0.558). Pathway model analysis indicated a direct protective effect of preoperative statins therapy on PC-AKI (P < 0.001), but not through its lipid-lowering effect (P = 0.277) nor anti-inflammatory effect (P = 0.596). Furthermore, it was found that “low-density lipoprotein cholesterol (LDL-C)→C-reactive protein (CRP)” mediated the relationship between preoperative statins therapy and PC-AKI (P = 0.007). However, this only explained less than 1% of the preoperative protective effects of statins on PC-AKI. Preoperative statins therapy is an independent protective factor of PC-AKI, regardless of its type. This protective effect is not achieved by lipid-lowering effect or anti-inflammatory effect. These findings underscore the potential use of statins in preventing PC-AKI among those at risk.

中文翻译：

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他汀类药物对造影后急性肾损伤的影响：一项多中心回顾性观察研究

造影后急性肾损伤 (PC-AKI) 是冠状动脉造影 (CAG) 和经皮冠状动脉介入治疗 (PCI) 的严重并发症。目前，他汀类药物对 PC-AKI 的影响及其机制尚不清楚。这项多中心回顾性观察性研究纳入了 2006 年 12 月至 2019 年 12 月在邵逸夫医院及其医疗财团医院接受 CAG 或 PCI 的 4386 名患者。记录 PCI 后 72 小时内的术前或术后血清肌酐。多变量逻辑回归用于探讨术前使用他汀类药物是否对 PC-AKI 有保护作用。然后利用路径分析模型寻找他汀类药物的中介因素。共招募了4386名患者。研究人群的中位年龄为 68 岁，17.9% 患有 PC-AKI，83 岁。3% 术前他汀类药物治疗。他汀类药物治疗组患者PC-AKI的发生率显着降低。多变量回归表明，术前他汀类药物治疗与较低比例的肌酐升高（β：-0.118，P < 0.001）和较少的 PC-AKI（OR：0.575，P < 0.001）显着相关。在术前他汀类药物治疗组中，阿托伐他汀组和瑞舒伐他汀组之间无统计学差异（OR：1.052，P = 0.558）。通路模型分析表明术前他汀类药物治疗对 PC-AKI 有直接保护作用（P < 0.001），但不是通过其降脂作用（P = 0.277）和抗炎作用（P = 0.596）。此外，发现“低密度脂蛋白胆固醇（LDL-C）→C反应蛋白（CRP）”介导了术前他汀类药物治疗与PC-AKI的关系（P=0.007）。然而，这仅解释了他汀类药物对 PC-AKI 术前保护作用的不到 1%。术前他汀类药物治疗是 PC-AKI 的独立保护因素，无论其类型如何。这种保护作用不是通过降脂作用或抗炎作用来实现的。这些发现强调了他汀类药物在高危人群中预防 PC-AKI 的潜在用途。这种保护作用不是通过降脂作用或抗炎作用来实现的。这些发现强调了他汀类药物在高危人群中预防 PC-AKI 的潜在用途。这种保护作用不是通过降脂作用或抗炎作用来实现的。这些发现强调了他汀类药物在高危人群中预防 PC-AKI 的潜在用途。