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

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.