Comparison of Combined/Carvedilol Moderate Dose Atorvastatin to Single High Dose Atorvastatin for the Prevention of Contrast-Induced Nephropathy after Cardiac Catheterization

Abstract

Background: Contrast-induced nephropathy (CIN) is associated with increased morbidity, and the need for short-term hemodialysis. Although several preventive measures have been used, the best approach to prevent CIN is still controversial. Objectives: This study is intended to evaluate the protective effect of carvedilol/ medium dose statin compared to the recommended high dose atorvastatin on the development CIN in patients undergoing elective cardiac catheterization (CC). Methods: A total of 144 patients planned for CC were randomly assigned to: • Group (A): 49 patients received atorvastatin as single high dose 80 mg 12 hours before CC and another 40 mg of atorvastatin 2 hours before PCI. • Group (B): 48 patients were prescribed carvedilol 12.5 mg twice daily for seven days before CC and continued for 24 hours post CC, plus 40 mg atorvastatin 12 hours before CC. • Group (C): 47 patients received 40 mg atorvastatin 12 hours before CC. Results: The baseline characteristics of the 3 groups were comparable. CIN incidence was the lowest in group A, but was not significantly different (p=0.420). CIN developed in 4 (8.2%), 6(12.2%), and 8(17%) patients in groups A, B, and C respectively. Median change in CrCl 48 hours, and serum NGAL 4 hours post CC was significantly lower in group A compared to group C (p=0.0330, p=0.0348 respectively). Conclusions: The present study revealed that, combined carvedilol/statin regimen was comparable to single high dose atorvastatin in CIN prevention. However, short high dose of atorvastatin might be preferable in terms of kidney function preservation.