Angiotensin-converting enzyme inhibitors and their effects on contrast-induced nephropathy after cardiac catheterization or percutaneous coronary intervention

Abstract

Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality in patients undergoing diagnostic procedures and/or interventional procedures in the cardiac catheterization laboratory. Angiotensin-converting enzyme inhibitor (ACEI) use has been implicated both as increasing the risk of developing CIN and as a protective factor against developing CIN. Because many patients who are referred for cardiac catheterization have comorbidities for which ACEIs are utilized, the precise role of these medications in the pathogenesis of CIN needs to be clarified. There is evidence both for and against a renoprotective effect of ACEIs in the development of CIN. However, virtually all clinical studies are relatively small studies and most of them are retrospective. Because of the important role that ACEIs play in the chronic treatment of the cardiac patient, further studies are warranted to define the role of the ACEIs in CIN when exposure to contrast is needed in this group of patients. Because CIN is an independent risk factor for increased morbidity and mortality in the cardiac patient, all efforts to decrease its incidence should be pursued. At the present time there is no compelling evidence for starting or stopping ACEIs before cardiac catheterization/coronary angiography or coronary intervention.