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Предикторы развития острой сердечной недостаточности у пациентов с инфарктом миокарда с подъемами сегмента ST электрокардиограммы после чрескожного коронарного вмешательства Ключевые слова: острая сердечная недостаточность, инфаркт миокарда, острое повреждение почек

Aim. To assess the prevalence and prognostic value of AKI in patients with acute decompensation of chronic heart failure (ADCHF) with a reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF) or acute coronary syndrome (ACS), to identify predictors of AKI.Materials and methods. In a prospective study included 863 patients, of which 141 with ADCHF, 446 – non-ST-elevation acute coronary syndromes (NSTE-ACS) and 276 – ST-segment elevation myocardial infarction (STEMI). AKI was diagnosed according to KDIGO recommendations. The end point was defined as death from cardiovascular causes.Result. During the follow-up from 1 to 37 months (median follow-up was 18 months) for patients with ADCHF in 24,8 % an endpoint was reported. For patients with ACS, the observation time ranged from 1 day to 14 months (median follow-up was 12 months), in 4,3 % – NSTE-ACS, 10,9 % – STEMI the end point was recorded. AKI developed in 14,8 % of patients with ADCHF HFpEF and 11,2 % ADCHF HFrEF, in 23,1 % – STEMI and 21,4 % – NSTE-ACS. AKI increases the risk of death from cardiovascular causes in patients with ADCHF HFrEF (OR 95 % 98,750 (11,158–873,976), р<0,001) and STEMI (OR 95 % 5,395 (2,451–11,878), p<0,001), but did not increase the risk of an endpoint occurrence in patients with ADCHF HFpEF (OR 95 % 1,875 (0,221–15,930), р=0,565) and NSTE-ACS (OR 95 % 1,199 (0,421–3,412), р=0,734). The multivariate analysis revealed risk factors for the development of AKI in patients with ADCHF HFrEF: high albuminuria (AU) from 30 mg / l (OR 95 % 5,763 (1,338–24,819), р=0,019), GFR<45 ml / min initially at admission to hospital (OR 95 % 76,593 (1,193–36,446), p=0,031), age>75 years (OR 15,933 (1,020–248,856), р=0,048). In patients with STEMI: age>75 years (OR 95 % 3,248 (1,476–7,146), p=0,003), female gender (OR 95 % 2,321 (1,190–4,526), p=0,013), acute heart failure (AHF) Killip IV (OR 95 % 10,334 (1,777–60,110), p=0,009). Risk factors for the development of AKI in patients with NSTE-ACS: age>75 years (OR 95 % 1,761 (1,051–2,949), р=0,032), PCI on RCA (OR 95 % 2,565 (1,193–5,517), р=0,016).Conclusion. In patients with ADCHF HFrEF and STEMI development AKI is associated with a poor prognosis, but does not affect the prognosis of patients with ADCHF HFpEF and NSTE-ACS. AKI in patients with ADCHF HFrEF can be predicted using predictors: GFR<45 ml / min, AU more than 30 mg / l and age>75 years. In patients with STEMI, the predictors of AKI were age>75 years, female gender, AHF Killip IV, and in patients with NSTE-ACS age>75 years, PCI on RCA.

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