Low Preoperative Mean Arterial Pressure as a Risk Factor for Contrast-Induced Nephropathy After Rotational Atherectomy.

Background: This study aimed to identify risk factors for contrast-induced nephropathy (CIN) following rotational atherectomy (RA) in patients with severely calcified coronary lesions to facilitate the prevention of CIN. Methods: A retrospective analysis was performed on 111 patients who underwent RA in Wuhan Fourth Hospital from July 2021 to June 2023. The creatinine levels of the patients were detected within 48-72 hours after RA, and the patients were divided into a CIN (n = 16) and a non-CIN group (n = 95). Propensity score matching was applied with a caliper value set at 0.02, resulting in 13 matched patient pairs. The risk factors for CIN after RA in these patients were analyzed. Results: A total of 16 cases of CIN occurred among the 111 patients with coronary heart disease who underwent RA. Following propensity score matching, 13 patients were included in both the CIN and non-CIN groups. The rates of heart failure were significantly higher in the CIN group than those in the non-CIN group before RA (all p < 0.05). However, there was no significant difference in preoperative mean arterial pressure (MAP) between the two groups. Nonetheless, the rate of patients with preoperative MAP <80 mmHg was higher in the CIN group than in the non-CIN group (53.8% vs. 7.7%; p < 0.05). The coronary artery lesion characteristics and interventional treatment strategies were comparable between the two patient groups. Moreover, no statistically significant difference was observed in 1-year major adverse cardiovascular and cerebrovascular events (MACCEs) or secondary endpoint events between the two groups. Logistic regression analysis showed that among the risk factors for CIN after RA, preoperative MAP <80 mmHg (odds ratio (OR) = 17.865, 95% confidence interval (CI): 1.135-281.246) was a risk factor for CIN (p < 0.05). Conclusion: Patients with a preoperative MAP below 80 mmHg are at increased risk of CIN following RA. This cohort requires intensive monitoring to prevent CIN, ensuring prompt implementation of management strategies to avert CIN onset and mitigate the adverse effects of CIN post-RA treatment.