Shotaro Kuji1, Masami Kosuge1, Kazuo Kimura1, Koichi Nakao2, Yukio Ozaki3, Junya Ako4, Teruo Noguchi5, Satoshi Yasuda5, Satoru Suwa6, Kazuteru Fujimoto7, Yasuharu Nakama8, Takashi Morita9, Wataru Shimizu10, Yoshihiko Saito11, Atsushi Hirohata12, Yasuhiro Morita13, Teruo Inoue14, Kunihiro Nishimura15, Yoshihiro Miyamoto15, Masaharu Ishihara16. 1. Division of Cardiology, Yokohama City University Medical Center. 2. Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center. 3. Department of Cardiology, Fujita Health University. 4. Department of Cardiovascular Medicine, Kitasato University Hospital. 5. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center. 6. Department of Cardiology, Juntendo University Shizuoka Hospital. 7. Department of Cardiology, National Hospital Organization Kumamoto Medical Center. 8. Department of Cardiology, Hiroshima City Hospital. 9. Division of Cardiology, Osaka General Medical Center. 10. Department of Cardiovascular Medicine, Nippon Medical School Hospital. 11. First Department of Internal Medicine, Nara Medical University. 12. Department of Cardiology, The Sakakibara Heart Institute of Okayama. 13. Department of Cardiology, Ogaki Municipal Hospital. 14. Department of Cardiovascular Medicine, Dokkyo Medical University. 15. Department of Preventive Cardiology, National Cerebral and Cardiovascular Center. 16. Division of Coronary Artery Disease, Hyogo College of Medicine.
Abstract
BACKGROUND: Acute kidney injury (AKI) is associated with poor outcome after acute myocardial infarction (AMI), but whether hemodynamic status at presentation influences this prognostic significance is unknown.Methods and Results: A total of 2,798 AMI patients admitted within 48 h after symptom onset and who underwent urgent coronary angiography were enrolled in the present study. AKI was defined as an increase in serum creatinine ≥0.3 mg/dL or ≥50% within 48 h during hospitalization. Patients were classified into 3 groups according to Killip class on admission: Killip 1, n=2,164; Killip 2-3, n=366; and Killip 4, n=268. AKI occurred more frequently with increasing Killip class (Killip 1, 2-3, and 4: 6.3%, 15.3%, and 31.3%, respectively; P<0.001). AKI was associated with increased in-hospital mortality, regardless of Killip class (non-AKI and AKI patients: 1.1% vs. 6.6% in Killip 1; 5.2% vs. 35.7% in Killip 2-3, and 28.8% vs. 45.2% in Killip 4, P<0.01 for all). On multivariate analysis, the adjusted OR of AKI for in-hospital mortality in Killip 1, Killip 2-3, and Killip 4 were 3.79 (95% CI: 1.54-9.33, P=0.004), 5.35 (95% CI: 2.67-10.7, P<0.001), and 1.48 (95% CI: 0.94-2.35, P=0.093), respectively. CONCLUSIONS: In AMI patients undergoing urgent coronary angiography, AKI was significantly associated with increased in-hospital mortality in Killip 1 as well as Killip 2-3 at presentation, but not in Killip 4.
BACKGROUND:Acute kidney injury (AKI) is associated with poor outcome after acute myocardial infarction (AMI), but whether hemodynamic status at presentation influences this prognostic significance is unknown.Methods and Results: A total of 2,798 AMI patients admitted within 48 h after symptom onset and who underwent urgent coronary angiography were enrolled in the present study. AKI was defined as an increase in serum creatinine ≥0.3 mg/dL or ≥50% within 48 h during hospitalization. Patients were classified into 3 groups according to Killip class on admission: Killip 1, n=2,164; Killip 2-3, n=366; and Killip 4, n=268. AKI occurred more frequently with increasing Killip class (Killip 1, 2-3, and 4: 6.3%, 15.3%, and 31.3%, respectively; P<0.001). AKI was associated with increased in-hospital mortality, regardless of Killip class (non-AKI and AKI patients: 1.1% vs. 6.6% in Killip 1; 5.2% vs. 35.7% in Killip 2-3, and 28.8% vs. 45.2% in Killip 4, P<0.01 for all). On multivariate analysis, the adjusted OR of AKI for in-hospital mortality in Killip 1, Killip 2-3, and Killip 4 were 3.79 (95% CI: 1.54-9.33, P=0.004), 5.35 (95% CI: 2.67-10.7, P<0.001), and 1.48 (95% CI: 0.94-2.35, P=0.093), respectively. CONCLUSIONS: In AMI patients undergoing urgent coronary angiography, AKI was significantly associated with increased in-hospital mortality in Killip 1 as well as Killip 2-3 at presentation, but not in Killip 4.
Entities:
Keywords:
Myocardial infarction; Prognosis; Renal function