The scientists confirmed the necessity of early treatment of acute kidney injury (AKI) in reducing high-risk coronary diseases

A group of authors of the retrospective observational study on predictors of acute kidney injury (AKI) in high-risk ST-elevation myocardial infarction (STEMI) patients
A group of authors of the retrospective observational study on predictors of acute kidney injury (AKI) in high-risk ST-elevation myocardial infarction (STEMI) patients

Background

  • Acute kidney injury [AKI] frequently complicates treatment of ST-elevation myocardial infarction [STEMI] patients, treated by primary percutaneous coronary intervention [PPCI ] also known as coronary angioplasty.
  • Prevention of contrast-induced AKI, a decline in kidney function, is well established in current clinical practice
  • Factors other than contrast exposure have been suggested as major contributors to renal dysfunction in patients undergoing PPCI.

Why Was This Study Done?

  • The study was performed to assess the incidence and risk factors of AKI in high-risk STEMI patients, mostly treated by PPCI with implemented measures to prevent contrast-induced AKI.
  • High risk in STEMI patients was attributed to: older age, comorbidities, pulmonary edema or cardiogenic shock on admission, resuscitation before admission, delayed PPCI, complex coronary artery disease [CAD] and/or multistage procedures during PPCI

What Did the Researchers Do and Find?

  • We performed a retrospective study using data of 245 STEMI patients admitted to the Department of Medical Intensive Care Unit.
  • AKI developed in 13.9% of high-risk STEMI patients
  • AKI was associated significantly with comorbidities such as diabetes mellitus and prior MI, but also with prior resuscitation, admission and in-hospital acute heart failure, and hospital-acquired infection [HAI]
  • In-hospital, 30-day and 6-month mortalities were significantly increased in AKI patients in comparison to non-AKI ones
  • Significant independent predictors of AKI were prior resuscitation, HAI, and peak NT-proBNP

What Do These Findings Mean?

  • To reduce the risk of AKI in STEMI patients, early diagnosis and treatment of AKI and HAIs are advisable and necessary.

Slovenian language summary

Izhodišča

  • Akutna ledvična okvara [AKI] je pogost zaplet zdravljenja bolnikov z akutnim miokardnim infarktom z dvigom ST [STEMI], ki so imeli opravljeno primarno perkutano koronarno intervencijo [PPCI].
  • Preprečevanje s kontrastni sredstvom povzročene AKI je dobro uveljavljeno v sodobni klinični praksi
  • Razen izpostavitve kontrastnim sredstvom so pri bolnikih, ki so imeli opravljeno PPCI, ugotovljeni še drugi pomembni dejavniki ledvične disfunkcije.

Zakaj smo opravili raziskavo?

  • Raziskavo smo opravili, da ugotovimo incidence in dejavnike tveganja za nastanek AKI pri STEMI bolnikih z velikim tveganjem, ki so večinoma zdravljeni s PPCI in vsemi priporočenimi ukrepi za preprečevanje s kontrastom povzročene AKI.
  • Veliko tveganje pri STEMI bolnikih je bilo opredeljeno z višjo starostjo, spremljajočimi boleznimi, s pljučnim edemom ali kardiogenim šokom ob sprejemu, oživljanjem pred sprejemom, z zakasnitvijo PPCI, kompleksno koronarno arterijsko boleznijo [CAD] in/ali večstopenjskimi intervencijami med PPCI

Kaj so raziskovalci opravili in našli?

  • Opravili smo retrospektivno raziskavo podatkov 245 STEMI bolnikov  sprejetih na Oddelek intenzivne interne medicine.
  • AKI smo ugotovili pri 13,9% STEMI bolnikih z velikim tveganjem
  • AKI je bila pomembno povezana s spremljajočimi boleznimi kot je diabetes in predhodni miokardni infarkt, pa tudi s predhodnim oživljanjem, akutnim srčnim popuščanjem ob sprejemu in med zdravljenjem in z bolnišnično okužbo [HAI]
  • Bolnišnična, 30-dnevna in 6-mesečna umrljivost so bile pomembno večje pri bolnikih z AKI v primerjavi z bolniki brez AKI.
  • Pomembni neodvisni napovedniki AKI so bili: predhodno oživljanje, HAI in visoke vrednosti NT-proBNP med zdravljenjem

Kaj pomenijo rezultati?

  • Da bi znižali tveganje za nastanek AKI pri STEMI bolnikih, je potrebno zlasti zgodnje prepoznavanje in zdravljenje akutnega srčnega popuščanja in HAI.
Reference
Andreja Sinkovič, Klara Masnik, Matic Mihevc. Predictors of acute kidney injury (AKI) in high-risk ST-elevation myocardial infarction (STEMI) patients: A single-center retrospective observational studyBosn J Basic Med Sci. 2018 Dec 27. doi: 110.17305/bjbms.2018.3797. [Epub ahead of print]

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