&lt;129&gt;Silymarin for the Prevention of Contrast Induced Nephropathy after Percutaneous Coronary Intervention in Patients with Acute ST Segment Elevation MI
Authors: Malik Aya , Atteya Abd El Rahman , EL Missiri Ahmed 
Published: August 2023

Aim and Objectives

To study the role of a single dose of silymarin in the prevention of CIN in patients with acute ST elevation MI undergoing primary percutaneous coronary intervention

Patients and Methods

The study included 200 patients with acute ST segment elevation myocardial infarction who underwent primary coronary angiography and percutaneous coronary intervention in the cardiology department, Ain Shams university. In the ER before the intervention, patients were randomized into 2 groups.

study group

Including 100 patients who received 300 mg Aspirin, 600 mg clopidogrel and single dose of silymarin 140 mg.

Control group

Including 100 patients who received 300 mg Aspirin and 600 mg clopidogrel. A nonionic, iso-osmolar contrast material was used. Serum creatinine was measured before and 48 h after injection of the contrast material. CIN was defined as an increase in creatinine of ≥ 0.5 mg/dL or ≥ 25% from the baseline.

Results

Serum creatinine was increased by 0.18 ± 0.28 mg/dL with silymarin and by 0.35 ± 0.42 mg/dL in non-silymarin group after contrast material injection with statistically significant difference (P-value 0.011). CIN occurred less frequently in silymarin group (12) than in nonsilymarin group (28) with statistically significant difference (P-value = 0.005). The contrast volume was higher in study group in comparison to the contrast volume in the control group which was a high statistically significant difference between the two groups with (P- value 0.000). There was a high statistically significant difference between the 2 groups regarding the whole time of the procedure and florotime with P-value = (0.003) and (0.002) respectively. There was statistically significant increase in the percentage of patients with baseline renal impairment in study group than control group with 38(38%) VS 22 (22%) respectively with (P-value = 0.014). While there was no statistically significant difference found between control group and study group regarding percentage of patients with HF symptoms, DM and HTN with (P-value = 0.451, 0.568 and 0.774) respectively. Regarding random blood sugar and Mehran score, there was no statistically significant difference between control group and study group. There was a high statistically significant difference between the 2 groups regarding the LVEF with (P-value = 0.000). There was a statistically significant difference found between control group and study group in diastolic blood pressure with (P-value 0.044). While there was no statistically significant difference between both groups in systolic blood pressure and heart rate. there was no statistically significant difference found between control group and study group regarding baseline demographic and anthropometric measures including age, gender, weight, height and BMI.

Conclusion

We found a trend toward the efficacy of silymarin in preventing contrast-induced renal dysfunction.

Abbreviations

HF: heart failure; CIN: contrast induced nephropathy; BMI: body mass index HR: heart rate; RI: renal impairment; STEMI: st elevation myocardial infarction; CKD: chronic kidney disease; CABG: coronary artery bypass graft; RBS: random blood sugar; AMI: acute myocardial infarction; GFR: glomerular filtration rate; CAD: coronary artery disease; IQR: interquartile range; ECG: electrocardiography; LVEF: left ventricle ejection fraction; DM: diabetes Miletus; PCI: Percutaneous coronary intervention; HTN: hypertension; S.cr: serum creatinine