Persistent Renal Dysfunction After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

Abstract

We determined the incidence, predictors, and outcomes of persistent renal dysfunction (PRD) following percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Among 16 264 patients enrolled in a nationwide registry, we studied patients with AMI who had their estimated glomerular filtration rate at baseline and 1 month later (n = 3606). We used multivariate regression and propensity score (PS)-matched Cox proportional hazards to evaluate the association between PRD and outcomes. Persistent renal dysfunction occurred in 1333 (37%) patients. Significant PRD contributors included old age, low body mass index (BMI), hypertension, Killip class, and the extent of vessel disease. Persistent renal dysfunction was associated with an increased 1-year major adverse cardiac events (all-cause death, myocardial infarction, or revascularization) relative to no-PRD (entire cohort: 6.2% vs 4.5%, hazard ratio[HR] 1.63, 95% confidence interval [CI] 1.18-2.25, P = .003; PS-matched cohort: 7.2% vs 4.9%, HR 1.67, 95% CI 1.08-2.58, P = .022). In conclusion, PRD occurred in approximately one-third of patients with AMI following PCI. It was associated with old age, hypertension, low BMI, initial hemodynamic instability, and extent of vessel disease and was a predictor of worse outcomes at 1 year.

Increased Heart Rate during Walk Test Predicts Chronic-Phase Worsening of Renal Function in Patients with Acute Myocardial Infarction and Normal Kidney Function

“…These factors are different from those in previous reports [1,2,3,4,5,6], which reported various factors such as old age, low body mass index, baseline renal dysfunction, hemoglobin, troponin levels, diabetes mellitus, amount of contrast, nephrotoxic drugs, and in-hospital initial hemodynamic instability. Almost all of the previous reports included chronic kidney disease patients on the baseline [1,2,3,4,5], who are susceptible to contrast media, drugs, and hemodynamic instability [13]. Although we think that excluding the effect of chronic kidney disease is very beneficial when considering the mechanism of WRF, even in a report on patients with AMI and normal kidney function, the predictors were different from those of the present study [6].…”

“…In previous reports, the prevalence of chronic-phase WRF varied from 6.4 to 33% [1,2,3,4,5,6]. These wide ranges regarding the incidence of chronic-phase deterioration of renal function reported previously may be explained by differences in the study cohorts, the definition of WRF, and the variations in clinical practice between institutions [4]. Nevertheless, we observed that even in AMI patients with normal kidney function, deterioration of renal function was common.…”

“…Chronic-phase worsening renal function (WRF) in patients with acute myocardial infarction (AMI) has been associated with major adverse cardiac events and an incidence reported to range from 6.4–33% [1,2,3,4,5,6]. Therefore, countermeasures against chronic-phase WRF are important for the prevention of future cardiovascular events, and thus, it is necessary to clarify the cause of its occurrence.…”

“…Therefore, countermeasures against chronic-phase WRF are important for the prevention of future cardiovascular events, and thus, it is necessary to clarify the cause of its occurrence. A few studies [1,2,3,4,5,6] have reported various predictive factors of chronic-phase WRF, but there is no consistency on these factors. The presumed causes are differences in the study cohorts, the definition of WRF, and variations in clinical practice between institutions.…”

Impact of worsening renal function on peak oxygen uptake in patients with acute myocardial infarction

“…5 In addition, in regard to renal function in patients with AMI, it is important to consider AMI-induced worsening renal function (WRF). In previous reports, the prevalence of WRF ranged from 7.34% to 37%, [6][7][8][9][10] indicating that it is not uncommon. WRF patients have higher mortality and cardiovascular event rates than non-WRF patients, [6][7][8][9] and similar results have been reported in studies adjusted for CKD.…”