Clinical Research at the VA Adhir Shroff, MD, MPH Associate Professor University of Illinois-Chicago Jesse Brown VA Medical Center Disclosure Statement of Financial Interest *I have no conflicts with respect to this presentation

VA Cooperative Studies Health Disparities & Minority Health Merit Grants Cooperative Studies Program Million Veteran Program

http://www.research.va.gov/programs/csp/

Case Presentation 65 yo F with prior 3V-CABG, DM, HTN, EF 30% Admitted with worsening SOB and CP, +Tni Referred for coronary angiography Primary service is reluctant to send her due to Stage 4 CKD (Cr 1.8, CrCl 29.1mL/min, eGFR 30.11 mL/min/1.73m²)

Contrast-Induced AKI Multiple trials have demonstrated the adverse impact of CI-AKI on short/long term clinical outcomes and economics Therapies including prolonged saline or bicarbonate infusion or n-acetylcysteine have had conflicting results

PRESERVE Trial (PREVENTION OF SERIOUS ADVERSE EVENTS FOLLOWING ANGIOGRAPHY ) Multicenter, randomized clinical trial 7,680 patients undergoing coronary or non- coronary angiography At increased risk of developing CI-AKI Diabetes + eGFR <60 Any patient with eGFR <45

PRESERVE Trial (PREVENTION OF SERIOUS ADVERSE EVENTS FOLLOWING ANGIOGRAPHY ) IV fluids Pre-procedure: ≥3 ml/kg of study IV fluid over ≥1 hour (1-3 mL/kg/hr) During angiography: 1-1.5ml/kg of study IV fluid per hour Post-procedure: ≥6 ml/kg of study IV fluid over ≥4 hours NAC and placebo NAC or placebo (1200 mg orally): 1 hour prior 1 hour following twice daily for 4 days

PRESERVE Trial (PREVENTION OF SERIOUS ADVERSE EVENTS FOLLOWING ANGIOGRAPHY ) As of 1/2017, JBVA enrolled 80 patients 4754 patients enrolled: 4081 US, 673 Australia

Case Presentation 65 yo F with prior 3V-CABG, DM, HTN, EF 30% Admitted with worsening SOB and CP, +Tni Referred for coronary angiography Primary service is reluctant to send her due to Stage 4 CKD (Cr 1.8, CrCl 29.1mL/min, eGFR 30.11 mL/min/1.73m²) Enrolled in PRESERVE study, underwent cath and PCI of the native LCX. Required 110cc contrast. At 6 week follow-up, symptom-free, Cr 1.7

Questions????? Thank you. arshroff@uic.edu 312-485-4511