Acute ST-elevation myocardial infarction (STEMI) represents a critical cardiovascular emergency, with percutaneous coronary intervention (PCI) being the preferred treatment. Post-PCI, patients are prone to developing contrast-induced nephropathy (CIN), significantly increasing the risk of adverse events. Thus, early diagnosis and treatment are crucial.

This study aims to investigate the diagnostic value of serum levels of NOD-like receptor pyrin domain-containing 3 (NLRP3) and the dosage of contrast agents for CIN following PCI in patients with STEMI.

The study included 257 patients diagnosed with STEMI and undergoing emergency PCI at the First People's Hospital of Kashi from June to December 2022. Based on the occurrence of CIN within 24 to 48 hours post-PCI, participants were divided into two groups: 61 in the CIN group and 196 in the non-CIN group. Basic clinical data of patients were collected, along with the dosage of contrast agents used during the procedure. On the second day of hospitalization, fasting venous blood was drawn to assess renal function indicators, lipid profiles, blood glucose, and serum NLRP3 levels, alongside echocardiographic evaluation of the left ventricular ejection fraction (LVEF). Multivariate Logistic regression analysis was utilized to explore factors influencing CIN development. Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic value of serum NLRP3 levels and contrast agent dosage for CIN.

The CIN group showed a lower proportion of males, lower preoperative levels of uric acid and albumin, and higher levels of contrast agent dosage and NLRP3 compared to the non-CIN group (P<0.05). The multivariate Logistic regression analysis indicated that increased contrast agent dosage (OR=1.008, 95%CI=1.001-1.015, P=0.017) and elevated serum NLRP3 levels (OR=1.139, 95%CI=1.054-1.230, P=0.001) are risk factors for CIN. ROC curve analysis revealed that the area under curve (AUC) for contrast agent dosage, serum NLRP3 levels, and their combined use in diagnosing CIN post-PCI in acute myocardial infarction were 0.797 (95%CI=0.716-0.879), 0.885 (95%CI=0.828-0.942), and 0.939 (95%CI=0.896-0.981), respectively.

In patients with STEMI, contrast agent dosage and serum NLRP3 levels are risk factors for CIN following PCI and can serve as predictive indicators. The combined use of these factors offers a more definitive diagnostic value for CIN.

急性ST段抬高型心肌梗死（STEMI）是常见的心血管急危重症之一，首选治疗方式为经皮冠状动脉介入治疗（PCI），PCI术后患者多发造影剂肾病（CIN），CIN会显著增加患者不良事件发生风险，早诊断、早治疗尤为重要。

探讨血清NOD样受体热蛋白结构域相关蛋白3（NLRP3）水平、造影剂用量对STEMI患者PCI术后CIN的诊断价值。

纳入2022年6—12月在喀什地区第一人民医院确诊为STEMI且急诊行PCI术的257例患者为研究对象，根据PCI术后24、48 h是否发生CIN分为CIN组61例，非CIN组196例。收集患者基本临床资料，并记录患者术中造影剂用量。患者入院第2天抽空腹静脉血，检测肾功能指标、血脂、血糖等生化指标和血清NLRP3水平，同时心脏彩超检测左心室射血分数（LVEF）。采用多因素Logistic回归分析探究发生CIN的影响因素。绘制受试者工作特征（ROC）曲线评估血清NLRP3水平及造影剂用量对CIN的诊断价值。

CIN组患者男性比例、术前血尿酸、白蛋白低于非CIN组，造影剂剂量、NLRP3高于非CIN组（P<0.05）。多因素Logistic回归分析结果表明，造影剂用量增加（OR=1.008，95%CI=1.001~1.015，P=0.017）、血清NLRP3水平升高（OR=1.139，95%CI=1.054~1.230，P=0.001）是发生CIN的危险因素。ROC曲线结果显示造影剂用量、血清NLRP3水平以及二者联合应用诊断急性心肌梗死PCI术后CIN的ROC曲线下面积（AUC）分别为0.797（95%CI=0.716~0.879）、0.885（95%CI=0.828~0.942）、0.939（95%CI=0.896~0.981）。

在STEMI患者中，造影剂用量和血清NLRP3水平是PCI术后CIN的危险因素，可作为PCI术后CIN的预测指标，二者联合应用对CIN的诊断价值较为明确。