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Updated: May 20, 2025
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Early versus Late Acute Kidney Injury in Patients Undergoing Primary Percutaneous Coronary Intervention
Inbal Greenberg1, Yacov Shacham2,3, Maayan Konigstein2,3
1The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel, inbalgreenb@gmail.com.
Insights
Early acute kidney injury (AKI) after percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients predicts higher mortality. This early AKI, occurring within 1.5 days, is linked to cardiogenic shock.
Area of Science:
- Cardiology
- Nephrology
- Clinical Outcomes Research
Background:
- Acute kidney injury (AKI) is a common complication in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
- AKI following PCI is associated with increased short- and long-term mortality, but the prognostic significance of AKI onset timing is unclear.
Purpose of the Study:
- To investigate the timing of AKI development after PCI in STEMI patients.
- To determine the prognostic significance of early versus late AKI on patient outcomes.
Main Methods:
- Retrospective cohort study of 2,912 STEMI patients who underwent successful PCI.
- AKI diagnosis and timing based on Kidney Disease Improving Global Outcomes (KDIGO) criteria using routine blood tests.
- Primary endpoint: all-cause mortality.
Main Results:
- 222 patients (7.6%) developed AKI, classified as early (within 1.5 days, n=108) or late (after 1.5 days, n=114).
- Early AKI was associated with higher cardiogenic shock incidence, lower left ventricular ejection fraction, and increased 30-day mortality compared to late AKI.
- Early AKI independently predicted long-term mortality (aHR 1.8), and cardiogenic shock predicted early AKI (aOR 2.3).
Conclusions:
- Early AKI following PCI in STEMI patients is linked to worse short- and long-term mortality.
- STEMI patients presenting with cardiogenic shock are more likely to develop early AKI.
Introduction:
Acute kidney injury (AKI) frequently complicates ST-elevation myocardial infarction (STEMI) in patients undergoing primary percutaneous coronary intervention (PCI) and is associated with increased short- and long-term mortality. However, the impact of the AKI onset time following PCI on patient outcomes remains uncertain. This study aimed to investigate the timing of post-PCI AKI development and its prognostic significance in STEMI patients.
Methods:
This retrospective cohort study included 2,912 STEMI patients who underwent successful PCI upon admission. The timing of AKI was determined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria, using routine blood tests conducted during hospitalization. The primary endpoint was all-cause mortality.
Results:
Among 2,912 STEMI patients studied, 222 (7.6%) developed AKI. AKI was classified as early if it occurred within 1.5 days (n = 108, 48.6%) or late if it occurred after 1.5 days (n = 114, 51.4%). Early AKI was associated with a significantly higher incidence of cardiogenic shock at presentation, lower post-PCI left ventricular ejection fraction, and increased 30-day mortality compared to late AKI. In a multivariate Cox regression analysis, early AKI emerged as an independent predictor of long-term mortality (adjusted HR 1.8, 95% CI 1.1-2.8, p = 0.015). Additionally, multivariate logistic regression analysis identified cardiogenic shock as a significant predictor of early AKI (adjusted OR 2.3, 95% CI 1.1-4.9, p = 0.03).
Conclusion:
In STEMI patients, early AKI - compared to late AKI - is associated with higher short- and long-term mortality and occurs more frequently in those presenting with cardiogenic shock.
