1. 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

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

4. 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 mL/min/1.73m²)

5. 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

6. 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

7. 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

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

9. 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 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

10. Questions?????
Thank you.