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Acute Cardio-Renal Syndrome as a Cause for Renal Deterioration Among Myocardial Infarction Patients Treated With
Yacov Shacham1, Eran Leshem-Rubinow1, Amir Gal-Oz2
1Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Insights
Acute kidney injury (AKI) risk in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) is linked to hemodynamic impairment, not just contrast nephropathy. Early recognition of these hemodynamic issues is crucial for AKI prevention.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Hemodynamic instability is a common complication of myocardial injury.
- Limited data exist on the direct association between hemodynamic derangement and acute kidney injury (AKI) in ST-elevation myocardial infarction (STEMI) patients post-primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate the effect of acute hemodynamic derangement on the risk of AKI in STEMI patients undergoing primary PCI.
- To identify predictors of AKI in this patient population.
Main Methods:
- Retrospective analysis of 1656 consecutive STEMI patients treated with primary PCI (2008-2014).
- Review of medical records for hemodynamic parameters and AKI occurrence.
- Multivariate logistic regression to identify independent predictors of AKI.
Main Results:
- AKI occurred in 10% of patients (168/1656).
- Independent predictors of AKI included critical state (OR 3.33), reduced left ventricular ejection fraction (OR 0.95), and congestive heart failure (OR 2.34).
- Hemodynamic impairment, including critical state, heart failure, arrhythmias, and worse LV function, was significantly associated with AKI (P < 0.001).
Conclusions:
- AKI in STEMI patients post-primary PCI is not solely due to contrast-induced nephropathy.
- Acute hemodynamic abnormalities are significant independent predictors of AKI and should be considered.
- Clinical attention should focus on hemodynamic status to mitigate AKI risk.
Background:
Early hemodynamic impairment frequently complicates myocardial injury, however, limited data are present regarding its direct association with acute kidney injury (AKI) after ST segment elevation myocardial infarction (STEMI) in patients who undergo primary percutaneous coronary intervention (PCI). We evaluated the effect of acute hemodynamic derangement on the risk of AKI among STEMI patients who undergo primary PCI.
Methods:
We performed a retrospective analysis of 1656 consecutive patients admitted with the diagnosis of STEMI between January 2008 and December 2014, and treated with primary PCI. Medical records were reviewed for the presence of various clinical parameters of hemodynamic derangement and for the occurrence of AKI.
Results:
Mean age was 61 ± 13 and 1329 (80%) were men. AKI occurred in 168 patients (10%). Patients with AKI were older, of female sex, with more comorbidities, had longer time to reperfusion, and were more likely to have hemodynamic impairment including critical state, congestive heart failure, life-threatening arrhythmias, and worse left ventricular function (P < 0.001 for all). In a multivariate logistic regression model critical state (odds ratio [OR], 3.33; 95% confidence interval [CI], 1.39-7.8; P = 0.006), reduced left ventricular ejection fraction (OR, 0.95; 95% CI, 0.92-0.99; P = 0.03), congestive heart failure (OR, 2.34; 95% CI, 1.02-5.39; P = 0.04), and a trend for time to coronary reperfusion (OR, 1.01; 95% CI, 1.00-1.01; P = 0.07) emerged as independent predictors of AKI.
Conclusions:
Among STEMI patients who underwent primary PCI AKI should not be assumed to be solely contrast-induced nephropathy and acute hemodynamic abnormalities should be considered.
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