OBJECTIVE: To evaluate the clinical and prognostic relevance of acute kidney injury (AKI) in the setting of ST-elevation acute myocardial infarction (STEMI) complicated by cardiogenic shock (CS). DESIGN: Prospective study. SETTING: Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center. PATIENTS: Ninety-seven consecutive STEMI patients with CS at admission, undergoing intra-aortic balloon pump (IABP) support and primary percutaneous coronary intervention (PCI). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We measured serum creatinine at baseline and each day for the following 3 days. Acute kidney injury was defined as a rise in creatinine >25% from baseline. Overall, AKI occurred in 52 (55%) patients, and in 12 of these patients, a renal replacement therapy was required. In multivariate analysis, age >75 yrs (p = .005), left ventricular ejection fraction < or = 40% (p = .009), and use of mechanical ventilation (p = .01) were independent predictors of AKI. Patients developing AKI had a longer hospital stay, a more complicated clinical course, and significantly higher mortality rate (50% vs. 2.2%; p <.001) than patients without AKI. In our population, AKI was the strongest independent predictor of in-hospital mortality (relative risk 12.3, 95% confidence intervals 1.78 to 84.9; p <.001). CONCLUSIONS: In patients with STEMI complicated by CS, AKI represents a frequent clinical complication associated with a poor prognosis.
OBJECTIVE: To evaluate the clinical and prognostic relevance of acute kidney injury (AKI) in the setting of ST-elevation acute myocardial infarction (STEMI) complicated by cardiogenic shock (CS). DESIGN: Prospective study. SETTING: Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center. PATIENTS: Ninety-seven consecutive STEMI patients with CS at admission, undergoing intra-aortic balloon pump (IABP) support and primary percutaneous coronary intervention (PCI). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We measured serum creatinine at baseline and each day for the following 3 days. Acute kidney injury was defined as a rise in creatinine >25% from baseline. Overall, AKI occurred in 52 (55%) patients, and in 12 of these patients, a renal replacement therapy was required. In multivariate analysis, age >75 yrs (p = .005), left ventricular ejection fraction < or = 40% (p = .009), and use of mechanical ventilation (p = .01) were independent predictors of AKI. Patients developing AKI had a longer hospital stay, a more complicated clinical course, and significantly higher mortality rate (50% vs. 2.2%; p <.001) than patients without AKI. In our population, AKI was the strongest independent predictor of in-hospital mortality (relative risk 12.3, 95% confidence intervals 1.78 to 84.9; p <.001). CONCLUSIONS: In patients with STEMI complicated by CS, AKI represents a frequent clinical complication associated with a poor prognosis.
Authors: S J Klein; F Husain-Syed; C Karagiannidis; G F Lehner; K Singbartl; M Joannidis Journal: Med Klin Intensivmed Notfmed Date: 2018-08-09 Impact factor: 0.840
Authors: S Kul; H Uyarel; O T Kucukdagli; M Turfan; M A Vatankulu; A Tasal; E Erdogan; E Asoglu; M Sahin; T S Guvenc; O Goktekin Journal: Herz Date: 2014-03-09 Impact factor: 1.443