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

Abstract

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.

Predictors of acute kidney injury (AKI) in high-risk ST-elevation myocardial infarction (STEMI) patients: A single-center retrospective observational study

“…In addition, low cardiac output, tubuloglomerular feedback, increased intra-abdominal pressure or increased venous pressure may result in kidney congestion [24]. Similar to our results, other studies on STEMI patients undergoing PPCI showed that AHF was an independent predictor of AKI [2,8,11,12,21,25,26].…”

“…Variables identified as significant and independent predictors of AKI were peak NT-proBNP ≥400 pmol/L, which is indicative of AHF, as well as HAI and resuscitation before admission. In previous studies, the incidence of AKI in STEMI or acute coronary syndrome (ACS) patients, based on the AKIN or KDIGO criteria, ranged between 10% and18% [3,11,12,[19][20][21]. Moreover, Shacham et al reported that the AKI incidence was 6.2% in STEMI patients with preserved EF before PPCI [10].…”

“…In STEMI patients, systemic hypoperfusion, which occurs as a consequence of acute left ventricular (LV) systolic dysfunction and results in renal ischemia, appears to be important pathological mechanism underlying AKI [2,10,11]. Other factors that contribute to AKI in STEMI patients are contrast media volume (contrast-induced nephrotoxicity), increased sympathetic activity and neurohumoral activation (e.g., upregulation of angiotensin II, epinephrine and norepinephrine), enhanced inflammatory response, oxidative stress, hyperglycemia, bleeding, hypovolemia, and nephrotoxic drugs [1,2,8,9,12].…”

Contrast-Induced Acute R enal Injury After Percutaneous Coronary InterventionI in Patients With ST-Segment Elevation Myocardial Infarction

“…Согласно данным J. Matějka и соавт., леталь ность у пациентов с ИМпST и КИОПП достигала 24 %, в то время как у пациентов без КИОПП -3,4 % (p=0,001) [28]. Эти данные согласуются с полученными нами результатами -летальность у пациентов с КИОПП и без КИОПП составила 14,5 и 6,1 % соответственно (p=0,037).…”

Mortality Reduction in Acute Coronary Syndromes — How Far Are We From The Goal?

“…Renal failure proved to be strongly associated with a higher risk of death following PCI in acute cases, in a significantly higher extent than in stable coronary artery disease. A recent study demonstrated a double relative risk associated with renal failure in STEMI cases (odds ratio 5.3) as compared with ACS cases (odds ratio 2.1), and with stable coronary artery disease (odds ratio 2.3) [3].…”