Feasibility and safety of noncontrast percutaneous coronary intervention in patients with complicated acute coronary syndrome

Objectives This study aimed to examine the feasibility and safety of noncontrast percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Background Contrast-induced acute kidney injury (CI-AKI) occurs in 10-20% of ACS patients undergoing PCI, resulting in poor short- and long-term prognoses. Reducing the amount of contrast medium can prevent CI-AKI. Methods This was a prospective single-center study. In successful noncontrast PCI, contrast medium was not injected from guiding catheter engagement to wire removal in ad-hoc PCI. Coronary angiography after PCI was permitted once. CI-AKI was defined as an increase in the serum creatinine level of >= 0.5 mg/dl or >= 1.25 times the baseline within 72 hr post PCI. Worsening renal function (WRF) was defined as an increase in the serum creatinine level of >= 0.3 mg/dl from baseline after PCI. Results This study included 106 lesions from 81 patients. Forty-eight (45%) lesions were Type C lesions. Successful noncontrast PCI was performed in 95 (90%) lesions. CI-AKI, coronary perforation, no/slow flow, and periprocedural death were observed in 4 (5%), 0, 9 (11%), and 0 patients, respectively. The follow-up period was 348 (190-492) days. Six-month WRF was observed in 18 individuals (22%). While successful noncontrast PCI was not associated with the incidence of CI-AKI, successful noncontrast PCI was inversely associated with WRF (hazard ratio, 0.28; 95% confidence interval, 0.09-0.90) after adjustment for renal function. Conclusions The present study suggests that noncontrast PCI is feasible and can be safely performed in ACS patients with complex lesions.