Alongside other established clinical risk factors, procedural complexity is an important parameter to take into account in tailoring upfront duration of DAPT.

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Objective To investigate the long-term prognostic implications of contrast-induced acute kidney injury (CI-AKI) with transient or persistent renal dysfunction in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). Design A retrospective observational registry study. Setting Clinical follow-up after PCI. Patients and methods A total of 1041 PCI-treated AMI patients from the Infarction Prognosis Study registry. CI-AKI was defined as an increase in serum creatinine (>25% or >0.5 mg/dl (>44.2 mmol/l)) within 2 days after PCI. Main outcome measures Two-year cumulative event rate of all-cause death or renal failure requiring dialysis. Results CI-AKI was observed in 148 patients (14.2%). Patients with CI-AKI had a higher rate of death or dialysis (25.4% vs 6.3%, p<0.001) at 2 years compared with patients without CI-AKI. CI-AKI was an important independent predictor of death or dialysis (HR 2.76, 95% CI 1.61 to 4.73, p<0.001) Persistent renal dysfunction after CI-AKI was documented in 68 patients (45.9%). Patients with transient renal dysfunction showed a lower 2-year event rate of death or dialysis compared with those with persistent renal dysfunction (17.9% vs 34.1%, p¼0.013); however, they showed a higher event rate compared with those without CI-AKI (17.9% vs 6.3%, p<0.001). Conclusion Transient and persistent renal dysfunction after CI-AKI was associated with increased short and longterm mortality and morbidity in AMI patients treated by PCI. Better preventive strategies are needed to improve clinical outcomes in AMI patients at high risk of developing CI-AKI.Contrast-induced acute kidney injury (CI-AKI) is generally considered a reversible form of acute renal failure that begins soon after iodinated contrast administration during angiographic procedures. This hospital-acquired complication is of great concern because of its adverse effects on patients' clinical outcomes, including prolonged hospitalisation and increased morbidity and mortality.1 2 Important predisposing factors for CI-AKI include female gender, older age, diabetes mellitus, pre-existing renal insufficiency, advanced heart failure and intravascular volume depletion. 3e5 The risk of CI-AKI is significantly higher among patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) than among the general population undergoing elective PCI. 6e10 The most likely contributing factors for CI-AKI in patients with AMI are haemodynamic instability or impaired systemic perfusion caused by left ventricular dysfunction, large volume of contrast medium, or insufficient time to perform renal prophylactic therapies during contrast medium exposure. 7 The purpose of this study was to determine the incidence of CI-AKI in patients with AMI undergoing PCI and to evaluate clinical predictors and long-term prognostic implications of CI-AKI in these patients. METHODS Study populationThe registry of the Infarction Prognosis Study, a prospective single-centre cohort study, is maintai...

High-dose atorvastatin pre-treatment before PCI did not show a significant reduction of MACEs compared with low-dose atorvastatin but did show improved immediate coronary flow after primary PCI. High-dose atorvastatin may produce an optimal result for STEMI patients undergoing PCI by improving microvascular myocardial perfusion. (Efficacy of High-Dose AtorvaSTATIN Loading Before Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction [STATIN STEMI]; NCT00808717).