Turk Kardiyol Dern Ars. Ahead of Print: TKDA-84401 | DOI: 10.5543/tkda.2019.84401
Effect of Acute Kidney Injury on Long-Term Mortality in Patients with ST-Segment Elevation Myocardial Infarction Complicated with Cardiogenic Shock and Underwent Primary Percutaneous Coronary Intervention in a High-Volume Tertiary Center
Mert İlker Hayıroğlu1
, Emrah Bozbeyoglu1
, Özlem Yıldırımtürk1
, Ahmet İlker Tekkeşin1
, Seçkin Pehlivanoğlu21
Dr. Siyami Ersek Thoracic And Cardiovascular Surgery Center Training And Research Hospital,Department of Cardiology, Istanbul/Turkey2
Başkent University Faculty of Medicine,Department of Cardiology, İstanbul, Turkey
Acute kidney injury (AKI) indicates both renal and cardiac reserve in patients with ST-segment elevation myocardial infarction(STEMI), but there is a lack of evidence in regard to effect of AKI on long-term mortality in patients with STEMI. We investigated the prognostic value of AKI for long-term mortality in patients with STEMI complicated with cardiogenic shock(CS) and underwent primary percutaneous coronary intervention(PPCI).
In this retrospective analysis, we evaluated the long-term prognostic impact of AKI on 492patients with STEMI complicated with CS treated with PPCI. ≥0.3mg/dl increase in serum creatinine, ≥50% increase in serum creatinine, or a reduction in urine output (documented oliguria of less than 0.5ml/kg per hour >6hours) was defined as AKI. Patients were grouped into two according to the incidence of AKI and long-term mortality was compared between those groups. Cox regression analysis was used to determine the independent prognostic factors of long-term mortality.
In Cox regression analysis, the age- and sex- adjusted hazard ratios (HRs) were higher for all-cause mortality in patients with AKI. (HR4.556;95% confidence interval (CI)2.3708.759) After adjustment for confounding variables, the relative risk was higher for patients with AKI in comparison to patients without AKI. (HR 2.207;95% CI1.150 4.739) Age (p<0.001,HR1.060,95% CI1.0271.094), ejection fraction (p=0.012,HR0.952, 95%CI0.916-0.989), BUN level (p=0.010,HR1.019,95% CI1.0051.034) and AKI (p=0.031,HR2.244, 95% CI1.0774.676) were found independent factors to determine long-term mortality.
Our study demonstrated that AKI is an independent prognostic factor for long-term mortality of patients with STEMI complicated with CS treated with PPCI.
Acute kidney injury, cardiogenic shock, myocardial infarction
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Corresponding Author: Mert İlker Hayıroğlu, Türkiye