Prognostic Implications of Acute Renal Impairment among ST Elevation Myocardial Infarction Patients with Preserved
Yacov Shacham1, Amir Gal-Oz2, Jeremy Ben-Shoshan1
1Departments 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) in ST-elevation myocardial infarction (STEMI) patients with preserved left ventricular function is linked to increased long-term mortality. This finding highlights the importance of monitoring kidney function post-primary PCI.
Area of Science:
- Cardiology
- Nephrology
- Clinical Research
Background:
- Limited data exists on acute kidney injury (AKI) incidence and outcomes in ST-elevation myocardial infarction (STEMI) patients with preserved left ventricular (LV) function.
- The primary percutaneous coronary intervention (PCI) era has changed STEMI management, necessitating updated understanding of AKI's role.
Purpose of the Study:
- To investigate the incidence and prognostic implications of AKI in STEMI patients with preserved LV function undergoing primary PCI.
- To assess the association between AKI and long-term all-cause mortality in this specific patient cohort.
Main Methods:
- Retrospective study of 842 STEMI patients with ejection fraction ≥50% who underwent primary PCI (Jan 2008 - Jan 2015).
- AKI defined as serum creatinine increase ≥0.3 mg/dl within 48 hours of admission.
- All-cause mortality assessed up to 5 years post-admission.
Main Results:
- AKI developed in 6.2% of patients (52/842).
- AKI patients were older, had poorer baseline renal function, and higher rates of heart failure.
- AKI was associated with significantly higher 5-year all-cause mortality (13.4% vs. 2.4%, p < 0.001).
- Adjusted hazard ratio for all-cause mortality in AKI patients was 2.64 (p = 0.01).
Conclusions:
- Acute kidney injury is a significant complication in STEMI patients with preserved LV function undergoing primary PCI.
- AKI is independently associated with increased long-term all-cause mortality in this population.
- Findings underscore the need for vigilance regarding kidney function in STEMI patients with preserved LV function post-PCI.
Background:
Only limited data is present regarding the incidence and prognostic implications of acute kidney injury (AKI) in ST elevation myocardial infarction (STEMI) patients with preserved left ventricular (LV) function in the primary percutaneous coronary intervention (PCI) era.
Methods:
We conducted a retrospective study of 842 consecutive STEMI patients with preserved LV function (ejection fraction ≥50%, assessed by echocardiography) who underwent primary PCI between January 2008 and January 2015. AKI was defined as an increase of ≥0.3 mg/dl in serum creatinine within 48 h following admission. Patients were assessed for all-cause mortality up to 5 years.
Results:
Fifty-two patients (6.2%) developed AKI. Patients with AKI were older, had impaired baseline renal function, and presented more often with heart failure throughout their hospitalization. Patients with AKI had a higher 5-year all-cause mortality (13.4 vs. 2.4%, p < 0.001). Compared to patients with no AKI, the adjusted hazard ratio for all-cause mortality was 2.64 (95% CI 1.25-5.56, p = 0.01).
Conclusions:
Among STEMI patients with preserved LV function undergoing primary PCI, AKI is associated with a higher long-term mortality.
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