Baseline atrial fibrillation is associated with contrast-induced nephropathy after cardiac catheterization in coronary artery disease: Systemic review and meta-analysis

Background: Atrial fibrillation (AF) is the most common arrhythmia, independently associated with significant mortality and morbidity. Recent studies suggest that AF is potentially associated with contrast-induced nephropathy (CIN) in patients with coronary artery disease (CAD) undergoing catheterization. However, the association was not conclusive. Thus, we assessed the association between AF in patients with CAD and CIN by a systematic review of the literature and a meta-analysis. Hypothesis: AF is a predictor of CIN in patients with CAD. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to April 2018. Included studies were published observational studies that compared the risk of CIN among CAD patients with AF vs those without AF. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals (CIs). Results: Eight cohort studies from June 2007 to November 2017 were included in this meta-analysis involving 16,691 subjects with CAD (1,030 with AF and 15,661 without its presence). The presence of AF was associated with CIN (pooled risk ratio = 2.17, 95% CI: 1.50-3.14, P < 0.001, I ² = 54.1%). In our subgroup analysis by urgency and multivariable adjustment, both groups still showed substantial association between AF and CIN (P < 0.05). Conclusions: AF increased the risk of CIN up to two fold among patients with CAD compared to the absence of it. Our study suggests that the presence of AF in CAD is prognostic for the development of CIN.