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Contrast-induced acute kidney injury and mortality in ST elevation myocardial infarction treated with primary
Johanne Silvain1, Lee S Nguyen1, Vincent Spagnoli1
1ACTION Study Group, Sorbonne Universités - Univ Paris 6 (UPMC), INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
Insights
Contrast-induced acute kidney injury (CI-AKI) is a serious complication after ST-elevation myocardial infarction (STEMI) treatment. The RIFLE definition accurately identifies patients at high risk of mortality or dialysis following primary percutaneous coronary intervention (pPCI).
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Contrast-induced acute kidney injury (CI-AKI) is a significant complication in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI).
- Current definitions for CI-AKI lack consensus, hindering accurate risk stratification for adverse outcomes such as mortality and dialysis.
- Identifying reliable CI-AKI definitions is crucial for managing STEMI patients receiving contrast media during pPCI.
Purpose of the Study:
- To evaluate the association of four different CI-AKI definitions with in-hospital mortality.
- To assess the predictive value of these CI-AKI definitions for 1-year mortality and the need for haemodialysis.
- To identify the most accurate CI-AKI definition for risk stratification in STEMI patients treated with pPCI.
Main Methods:
- A prospective, observational study included 1114 consecutive STEMI patients treated with pPCI.
- CI-AKI was assessed using four definitions: CIN, Acute Kidney Injury Network (AKIN), RIFLE-MDRD, and RIFLE-CKD-EPI.
- Independent variables associated with CI-AKI and mortality were identified.
Main Results:
- CI-AKI incidence varied by definition, ranging from 10.5% (RIFLE-CKD-EPI) to 18.3% (CIN).
- The RIFLE-CKD-EPI definition demonstrated the strongest association with increased in-hospital mortality (27.1% vs 4.0%), 1-year mortality (27.4% vs 6.6%), and 1-year haemodialysis requirement (15.6% vs 2.7%).
- Independent predictors of 1-year mortality included haemodynamic instability, cardiac arrest, pre-existing renal failure, advanced age, and high contrast media volume; contrast volume did not correlate with creatinine changes.
Conclusions:
- CI-AKI is a frequent and serious complication in STEMI patients undergoing pPCI.
- The RIFLE-CKD-EPI definition is the most effective for identifying patients at high risk of mortality or requiring haemodialysis.
- Accurate CI-AKI definition is essential for risk-stratifying STEMI patients post-pPCI.
Objectives:
Contrast-induced acute kidney injury (CI-AKI) is a common and potentially severe complication in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). There is no consensus on the best definition of CI-AKI to identify patients at risk of haemodialysis or death. The objective of this study was to assess the association of CI-AKI, using four definitions, on inhospital mortality, mortality or haemodialysis requirement over 1-year follow-up, in patients with STEMI treated with pPCI.
Methods:
In this prospective, observational study, all patients with STEMI referred for pPCI were included. We identified independent variables associated with CI-AKI and mortality.
Results:
We included 1114 consecutive patients with STEMI treated by pPCI. CI-AKI occurred in 18.3%, 12.2%, 15.6% and 10.5% of patients according to the CIN, Acute Kidney Injury Network (AKIN), Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) Modification of Diet in Renal Disease (MDRD) and RIFLE Chronic Kidney Disease - Epidemiology Collaboration (CKD-EPI) definitions, respectively. The RIFLE (CKD-EPI) definition was the most discriminant definition to identify patients at higher risk of inhospital mortality (27.1% vs 4.0%; adjusted OR 2.7 (95% CI 1.4 to 5.1), p=0.003), 1-year mortality (27.4% vs 6.6%; adjusted OR 2.8 (95% CI 1.5 to 5.3), p=0.002) and haemodialysis requirement at 1-year follow-up (15.6% vs 2.7%; adjusted OR 6.7 (95% CI 3.3 to 13.6), p=0.001). Haemodynamic instability, cardiac arrest, preexisting renal failure, elderly age and a high contrast media volume were independently associated with 1-year mortality. Of interest, contrast-media volume was not correlated to increase of creatininaemia (r=0.06) or decrease in estimated glomerular filtration rate (r=0.05) after percutaneous coronary intervention in our population.
Conclusions:
CI-AKI is a frequent and serious complication of STEMI treated by pPCI. The RIFLE definition is the most accurate definition to identify patients with CI-AKI at high risk of mortality or haemodialysis.
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