Comparison of the effects of carvedilol and metoprolol treatments on the development of contrast-induced nephropathy after percutaneous coronary intervention in patients presenting with acute coronary syndrome

Aim: Carvedilol has been shown to inhibit inflammation, vasoconstriction and oxidative stress, which play important roles in the development and progression of contrast-induced nephropathy (CIN). However, to the best of our knowledge, no studies have investigated the potential effect of carvedilol on the prevalence of CIN after percutaneous coronary intervention (PCI) in the setting of acute coronary syndrome (ACS). Herein, this study aimed to determine whether carvedilol use is associated with the development of CIN. Methods: Medical records of 319 patients (mean age, 59.19 ± 12.42 years; 77.7 % male) with ACS who underwent urgent PCI at our institution between May 2019 and April 2022 were included prospectively. Overall, 100 and 219 patients were assigned to the carvedilol and metoprolol succinate groups, respectively. Serum creatinine levels were examined preoperatively and 24–48 h postoperatively and compared between groups. Data were grouped according to the occurrence of CIN, and univariate analysis was conducted to exclude suspected influencing factors that led to CIN occurrence. Logistic regression analysis was performed, after adjusting for confounding factors, to assess the association between carvedilol administration (independent variable) and CIN occurrence (dependent variable). Results: CIN was detected in 46 (14.4%) patients. The prevalence of CIN was significantly lower in the carvedilol group (6.0%) than in the control group (18.3%; p=0.003). Results of the logistic regression analysis revealed that carvedilol (odds ratio [OR] 0.250, 95% confidence interval [CI] 0.092-0.677, p=0.006), amount of contrast agent (OR 1.004, 95%CI 1.000-1.008, p=0.031), and admission estimated glomerular filtration rate (OR 0.978, 95%CI 0.960-0.995, p=0.014) were independently associated with the development of CIN. Conclusion: The use of carvedilol, in addition to hydration therapy and statin administration appear to be a promising method for the prevention of CIN in patients with ACS undergoing urgent PCI. Further multicenter studies are required in this regard. Keywords: Contrast-induced nephropathy, Acute coronary syndrome, Carvedilol, Metoprolol