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Association of left ventricular function and acute kidney injury among ST-elevation myocardial infarction patients
Yacov Shacham1, Eran Leshem-Rubinow1, Amir Gal-Oz2
1Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Insights
Reduced left ventricular ejection fraction (EF) predicts acute kidney injury (AKI) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Lower EF is a strong independent risk factor for developing AKI post-PCI.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Acute kidney injury (AKI) is a frequent complication in ST-elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PCI).
- AKI in this population is linked to adverse long-term health outcomes.
- The relationship between cardiac function and AKI risk in STEMI patients undergoing PCI remains understudied.
Purpose of the Study:
- To investigate the association between echocardiographic measures of cardiac function and the incidence of AKI.
- To identify cardiac function parameters that independently predict AKI development in STEMI patients treated with primary PCI.
Main Methods:
- Retrospective analysis of 386 STEMI patients who underwent primary PCI and echocardiography within 72 hours of admission.
- AKI defined as a serum creatinine increase of ≥0.3 mg/dl within 48 hours of admission.
- Multivariate regression analysis to determine independent predictors of AKI.
Main Results:
- 34 patients (9.7%) developed AKI.
- Patients with AKI exhibited significantly lower left ventricular ejection fraction (EF), lower septal and lateral e' velocities, and higher E/e' ratio.
- Elevated systolic pulmonary artery pressure and right atrial pressure were also observed in patients with AKI.
Conclusions:
- Left ventricular ejection fraction (EF) is a significant and independent predictor of AKI in STEMI patients undergoing primary PCI.
- Echocardiographic assessment of cardiac function, particularly EF, can aid in risk stratification for AKI in this vulnerable patient group.
Abstract:
Acute kidney injury (AKI) is a common complication among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and it is associated with poor long-term clinical outcomes. No studies have yet evaluated the association between cardiac function and the risk of AKI in this patient population. We conducted a retrospective study of consecutive 386 patients with STEMI who underwent primary PCI and had a full echocardiography study performed within 72 hours of hospital admission from June 2011 to December 2013. AKI was defined as an increase of ≥0.3 mg/dl in serum creatinine within 48 hours after admission. Thirty-four patients (9.7%) developed AKI. Echocardiography demonstrated that patients with AKI had significantly lower systolic ejection fraction (EF; 48% ± 8% vs 41% ± 10%, p <0.001), lower septal (p = 0.001) and lateral (p = 0.01) e' velocities, higher average E/e' ratio (p = 0.006), elevated systolic pulmonary artery pressure (p <0.001), and higher right atrial pressure (p = 0.001). In multivariate regression analysis, left ventricular EF emerged as an independent predictor of AKI (odds ratio 1.1, 95% confidence interval 0.86 to 0.96; p = 0.001) for every 1% reduction in EF. In conclusion, among patients with STEMI undergoing primary PCI, left ventricular EF is a strong and independent predictor of AKI.
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