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Angiotensin-Converting Enzyme Inhibitors and Contrast-Associated Acute Kidney Injury After Coronary Angiography and Intervention

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Abstract

Contrast-associated acute kidney injury has multiple definitions, but is generally described as worsening renal function after administration of iodinated contrast media. It is associated with high in-hospital mortality and poor long-term survival. Furthermore, patients undergoing coronary angiography commonly have comorbidities such as hypertension or congestive heart failure, which are often treated with renin-angiotensin-aldosterone system-blocking agents such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Trials assessing the effects of these renin-angiotensin-aldosterone system-blocking agents on the subsequent development of contrast-associated acute kidney injury have shown conflicting data, suggesting both beneficial and harmful effects. Therefore, there are no clear guidelines on whether clinicians should discontinue renin-angiotensin-aldosterone system-blocking agents peri-procedurally. In this article, we review the data from trials assessing the effects of peri-procedural renin-angiotensin system-blocking agent use in patients undergoing coronary and peripheral angiography and intervention. Future studies will likely focus on the extent of damage or potential benefit of these agents on renal function, cardiac function, as well as morbidity and mortality. Currently, there is insufficient evidence to recommend discontinuation of angiotensin-converting enzyme inhibitors prior to coronary angiography.

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Authors and Affiliations

  1. Department of Medicine, Virginia Commonwealth University, McGuire VAMC, 1201 Broad Rock Boulevard 111J, Richmond, VA, 23249, USA

    Melissa Wasilewski, Sumon Roy, Nilang G. Patel & Ion S. Jovin

  2. McGuire Veterans Affairs Medical Center, Richmond, VA, USA

    Nilang G. Patel & Ion S. Jovin

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  1. Melissa Wasilewski
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Correspondence to Ion S. Jovin.

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The authors, Melissa Wasilewski, Sumon Roy, Nilang G. Patel, and Ion S Jovin, declare that they have no conflicts of interest relevant to the contents of this article.

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All authors made significant intellectual contributions to the design of the study and to the paper. MW wrote the first draft. All authors approved the final version of the paper Table 1. Summary of retrospective studies assessing the effects of ACEis and ARBs on incidence of CA-AKI.

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Wasilewski, M., Roy, S., Patel, N.G. et al. Angiotensin-Converting Enzyme Inhibitors and Contrast-Associated Acute Kidney Injury After Coronary Angiography and Intervention. Am J Cardiovasc Drugs 21, 487–497 (2021). https://doi.org/10.1007/s40256-020-00455-5

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