Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission*

Marenzi, Giancarlo; Assanelli, Emilio; Campodonico, Jeness; Metrio, Monica De; Lauri, Gianfranco; Marana, Ivana; Moltrasio, Marco; Rubino, Mara; Veglia, Fabrizio; Montorsi, Piero; Bartorelli, Antonio L.

doi:10.1097/ccm.0b013e3181b9eb3b

Cited by 154 publications

(157 citation statements)

References 43 publications

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“…Cardiogenic shock predicted AKI with 56% PPV. The fact that more than half of cardiogenic shock patients developed AKI was conformant with previously published data [9].…”

Section: Discussionsupporting

confidence: 90%

“…The volume of low-osmolar contrast agent administered (173 ± 42 mL) was lower than in older relevant trials or similar to recent trials [3,9,10]. MACD was exceeded in 3% of patients only.…”

Section: Discussionsupporting

confidence: 60%

“…STEMI patients treated by primary PCI represent a population at higher risk for AKI than those undergoing elective coronary angiography and/or PCI. Renal hypoperfusion caused by HF or prolonged hypotension, larger volume of contrast media, bleeding, and atheroembolic events during catheterisation are the most cited conditions that contribute to renal injury [3,9,10].…”

Section: Discussionmentioning

confidence: 99%

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Heart failure is the strongest predictor of acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

Matejka

Varvařovský²,

Rozsíval³

et al. 2016

Kardiol Pol

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A b s t r a c tBackground: ST elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PCI) are at higher risk of acute kidney injury (AKI) than patients undergoing PCI in stable clinical conditions. This fact suggests that mechanisms other than contrast nephrotoxicity are involved. Aim:To evaluate the incidence, risk factors, and consequences of AKI in patients undergoing primary PCI for STEMI in current daily practice. Methods:Analysis of all consecutive patients who underwent primary PCI over a one-year period. AKI was defined as an increase in serum creatinine ≥ 50% or 26.5 μmol/L (AKIN criteria) from the baseline within 48 h. Results:A total of 202 patients were included. AKI occurred in 25 (12.4%) subjects. Baseline characteristics and in-hospital complications of the patients with and without AKI did not differ significantly except for age (69 ± 13 vs. 62 ± 12; p = 0.003), female gender (48.0% vs. 26.6%; p = 0.035), hypertension (88.0% vs. 62.7%; p = 0.013), left ventricular ejection fraction (40% ± 12% vs. 49% ± 14%; p = 0.002), cardiogenic shock (44.0% vs. 5.1%; p < 0.0001), use of intravenous diuretics (76.0% vs. 26.0%; p < 0.0001), ventricular arrhythmias (24.0% vs. 3.4%; p = 0.001), and in-hospital mortality (24.0% vs. 3.4%; p = 0.001). In multivariate analysis heart failure remained the only independent correlate of AKI.Conclusions: AKI was an frequent and serious complication of STEMI in patients treated by primary PCI. Heart failure was the strongest predictor of AKI. Other risk factors including contrast medium volume, baseline renal function, diabetes, and age failed to predict AKI.

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“…Cardiogenic shock predicted AKI with 56% PPV. The fact that more than half of cardiogenic shock patients developed AKI was conformant with previously published data [9].…”

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Heart failure is the strongest predictor of acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

Matejka

Varvařovský²,

Rozsíval³

et al. 2016

Kardiol Pol

View full text Add to dashboard Cite

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“…In such patients, the prevalence of either chronic or cardiogenic shock-related renal dysfunction is much higher, as well as the incidence of AKI. 31 The small number of events may have led to a sort of overfitting of our models. Indeed, simple models using readily obtainable objective variables may be better fitted to lowrisk elective patients undergoing PCI than to patients with STEMI for whom other risk factors have to be taken into account.…”

Section: Limitationsmentioning

confidence: 99%

Renal Function–Adjusted Contrast Volume Redefines the Baseline Estimation of Contrast-Induced Acute Kidney Injury Risk in Patients Undergoing Primary Percutaneous Coronary Intervention

Andò

Gregorio

Morabito

et al. 2014

Circ: Cardiovascular Interventions

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Background-Age, estimated glomerular renal function (eGFR), and ejection fraction are preprocedural predictors of contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention. The effect of renal function-adjusted contrast volume (CV) remains not totally explored, and a threshold has not yet been established. Methods and Results-Logistic regression and receiver-operating characteristic curve analyses were used to assess whether CV/eGFR was an independent predictor of CI-AKI. The increased discriminative value of CV/eGFR over the preprocedural model based on age, eGFR, and ejection fraction was examined using the net reclassification improvement analysis. Of 470 patients enrolled, we observed 25 (5.3%) cases of CI-AKI. Patients with CI-AKI had received a higher renal function-adjusted CV (CV/eGFR 3.62 versus 1.96; P<0.001), and CI-AKI incidence was higher (15%; P<0.001) in patients in the highest quartile of CV/eGFR, corresponding to the cutoff indicated by the receiver-operating characteristic curve (>2.5; area under the curve, 0.77). At multivariable analysis, CV/eGFR above the cutoff (odds ratio, 5.57; P=0.002) remained an independent predictor of CI-AKI. The model with CV/eGFR demonstrated a statistically significantly net reclassification improvement of 0.23 (P=0.021) over the baseline preprocedural model, largely driven by a correct decrease in risk estimates for patients not experiencing CI-AKI, with a likelihood ratio χ 2 of 5.973 (P=0.029). Conclusions-CV remains a key risk factor for CI-AKI after primary percutaneous coronary intervention and our study supports the need for minimizing CV, independently from baseline preprocedural risk. A CV restricted to no more than twice and a half the baseline eGFR might be valuable in reducing the risk of CI-AKI. (Circ Cardiovasc Interv. 2014;7:465-472.)Key Words: acute kidney injury ◼ balloon coronary angioplasty ◼ contrast media adverse effects ◼ myocardial infarction

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“…23 When AMI is complicated by cardiogenic shock, AKI may affect over half of all patients. 24 However, these investigations did not strictly use the standardized criteria for diagnosing AKI. Some investigations used their own criteria to diagnose, while others used SCr at any timepoint or at 7 days.…”

Section: Discussionmentioning

confidence: 99%

Renal function, acute kidney injury and hospital mortality in patients with acute myocardial infarction

et al. 2014

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Objectives: To examine retrospectively the relationship between acute kidney injury (AKI) and acute myocardial infarction (AMI), and the association between estimated glomerular filtration rate (eGFR) at admission and AKI outcome. Methods: AKI was defined as an increase in serum creatinine (SCr) by !0.3 mg/dl within 48 h or an increase in SCr to !1.5 times baseline within the first 7 days of hospitalization. Patients with AMI were divided into subgroups according to their eGFR at admission and the development of AKI. Results: This study enrolled 396 patients with AMI; 48 (12.1%) developed AKI. In-hospital mortality was 39.6% (19/48) for patients with AKI compared with 7.5% (26/348) in those without AKI (odds ratio [OR] 8.11; 95% confidence interval [CI] 4.02, 16.39). The mortality rate was 35.7% (five of 14) in the eGFR ! 60 ml/min/1.73m 2 with AKI group (OR 6.21, 95% CI 1.50, 25.69) and 41.2% (14/34) in the eGFR < 60 ml/min/1.73m 2 with AKI group (OR 12.62, 95% CI 5.54, 28.74). Conclusions: AKI development was common and associated with mortality in AMI patients with either preserved or impaired eGFR levels.

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Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission*

Abstract: In patients with STEMI complicated by CS, AKI represents a frequent clinical complication associated with a poor prognosis.

Cited by 154 publications

References 43 publications

Heart failure is the strongest predictor of acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

Heart failure is the strongest predictor of acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

Renal Function–Adjusted Contrast Volume Redefines the Baseline Estimation of Contrast-Induced Acute Kidney Injury Risk in Patients Undergoing Primary Percutaneous Coronary Intervention

Renal function, acute kidney injury and hospital mortality in patients with acute myocardial infarction

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