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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Acute renal impairment in older adults treated with percutaneous coronary intervention for ST-segment elevation
Shafik Khoury1, Gilad Margolis, Zach Rozenbaum
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) is common in elderly patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). AKI significantly increases short-term and long-term mortality risks in this vulnerable population.
Area of Science:
- Cardiology
- Nephrology
- Geriatrics
Background:
- Elderly patients (≥75 years) are a growing demographic undergoing primary PCI for myocardial infarction.
- Limited data exist on acute kidney injury (AKI) incidence and outcomes in this specific elderly cohort.
Purpose of the Study:
- To determine the incidence of AKI in older adults (≥75 years) with STEMI treated with primary PCI.
- To evaluate the prognostic impact of AKI on mortality and renal function in this patient group.
Main Methods:
- Retrospective, observational, single-center study of 416 elderly patients (≥75 years) with STEMI.
- Primary PCI was the treatment modality.
- AKI defined as serum creatinine increase ≥0.3 mg/dL within 48 hours of admission.
Main Results:
- AKI developed in 23% (96/416) of patients.
- AKI was linked to worse in-hospital outcomes and significantly higher 30-day (25% vs 6%) and long-term mortality (46% vs 17%).
- Renal function recovery at discharge was observed in 48% of AKI patients; lack of recovery predicted new or progressive chronic kidney disease.
Conclusions:
- AKI is a frequent complication in elderly STEMI patients treated with primary PCI.
- AKI is associated with adverse short-term and long-term renal outcomes and increased mortality.
Background:
Elderly individuals ( ≥ 75 years) constitute an increasing proportion of patients presenting with myocardial infarction treated with primary percutaneous coronary intervention (PCI), but only limited data are available regarding the incidence and prognostic implications of acute kidney injury (AKI) in this group of patients.
Objective:
To evaluate the incidence and prognostic implications of AKI in older adults ( ≥ 75 years) with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI.
Patients And Methods:
A retrospective cohort, observational, single-center study of consecutive 416 older patients with STEMI (≥ 75 years) treated with primary PCI between January 2008 and August 2017 was conducted. AKI was defined as an increase of at least 0.3 mg/dl in serum creatinine within 48 h following admission.
Results:
A total of 96/416 (23%) patients developed AKI. The occurrence of AKI was associated with adverse in-hospital outcomes, higher 30 days (25 vs. 6%; P < 0.001), and long-term mortality (46 vs. 17%; hazard ratio: 3.2; 95% confidence interval: 2.1-4.7; P < 0.001). Among patients with AKI, 46/96 (48%) demonstrated recovery of renal function at hospital discharge. Lack of renal function recovery at discharge (50/96 patients; 52%) was associated with the occurrence of new or progression of baseline chronic kidney disease.
Conclusion:
Among older patients with STEMI undergoing primary PCI, AKI is a frequent complication associated with adverse renal short-term and long-term outcomes.
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