Acute Kidney Injury and Acute Myocardial Infarction

Ebina, Toshiaki; Kosuge, Masami; Kimura, Kazuo

doi:10.1253/circj.cj-14-0438

Circ J

2014

DOI: 10.1253/circj.cj-14-0438

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Acute Kidney Injury and Acute Myocardial Infarction

Toshiaki Ebina

Masami Kosuge

Kazuo Kimura

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Cited by 3 publications

(1 citation statement)

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“…8 Adverse hemodynamic conditions, metabolic changes, and alterations of the renal microvasculature caused by fibrin deposits and congestion with leukocytes have been suggested to contribute to the development of AKI. [9][10][11] Indeed, an analysis by Shacham et al 7 disclosed left ventricular (LV) ejection fraction assessed by echocardiography as an independent predictor of AKI. However, the association between the extent of myocardial damage and myocardial microvascular injury in particular, which is strongly associated with the post-STEMI inflammatory response and adverse outcomes, 12,13 and the development of AKI is currently unknown.…”

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confidence: 99%

Acute kidney injury is associated with microvascular myocardial damage following myocardial infarction

Reinstadler

Kronbichler

Reindl

et al. 2017

Kidney International

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Acute kidney injury (AKI) is a frequent complication in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention. However, the pathophysiology of AKI in this setting is complex and goes beyond the administration of contrast media. Studies assessing the impact of infarct characteristics on AKI are currently lacking. Therefore, we investigated the association of AKI with myocardial as well as microvascular injury in an initial total of 361 consecutive STEMI patients treated by primary percutaneous coronary intervention. Of these, 318 patients were included in final analysis. Serum creatinine was measured on admission as well as 24, 48, and 72 hours thereafter with AKI defined as an increase in serum creatinine of 0.3 mg/dl or more. Cardiac magnetic resonance (CMR) scans were performed in the first week after infarction, with microvascular injury visualized by late gadolinium enhancement CMR defined as any region of hypoenhancement within the hyperenhanced area of infarction. Sixteen patients developed AKI. They showed significantly lower left ventricular ejection fraction (45[interquartile range 40-52]% vs. 54[47-59]%), larger infarct size (21[15-35]% vs. 12[7-22]%) of left ventricular myocardial mass, and more frequent microvascular injury (81 vs. 46%) than those free of AKI. Meaningfully, in multivariate analysis including all CMR data, microvascular injury was the sole independent predictor of AKI (odds ratio 6.74, 95% confidence interval of 1.49-30.43). Thus, among revascularized STEMI patients, the presence of microvascular injury assessed by CMR was independently associated with an increased risk of AKI. This suggests a potential pathophysiological link between cardiac microvascular disease and renal injury following STEMI.

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confidence: 99%

Acute kidney injury is associated with microvascular myocardial damage following myocardial infarction

Reinstadler

Kronbichler

Reindl

et al. 2017

Kidney International

View full text Add to dashboard Cite

show abstract

Association of Left Ventricular Function and Acute Kidney Injury Among ST-Elevation Myocardial Infarction Patients Treated by Primary Percutaneous Intervention

Shacham

Leshem

Gal‐Oz

et al. 2015

The American Journal of Cardiology

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Acute Cardio-Renal Syndrome as a Cause for Renal Deterioration Among Myocardial Infarction Patients Treated With Primary Percutaneous Intervention

Shacham

Leshem

Gal‐Oz

et al. 2015

Canadian Journal of Cardiology

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Acute Kidney Injury and Acute Myocardial Infarction

Cited by 3 publications

References 17 publications

Acute kidney injury is associated with microvascular myocardial damage following myocardial infarction

Acute kidney injury is associated with microvascular myocardial damage following myocardial infarction

Association of Left Ventricular Function and Acute Kidney Injury Among ST-Elevation Myocardial Infarction Patients Treated by Primary Percutaneous Intervention

Acute Cardio-Renal Syndrome as a Cause for Renal Deterioration Among Myocardial Infarction Patients Treated With Primary Percutaneous Intervention

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