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KMID : 0311120110520040603
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Yonsei Medical Journal
2011 Volume.52 No. 4 p.603 ~ p.609
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Impact of Acute Kidney Injury on Clinical Outcomes after ST Elevation Acute Myocardial Infarction
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Kim Min-Jee
Choi Hong-Sang
Oh Seul-Hyun
Lee Hyung-Chul
Kim Chang-Seong
Choi Joon-Seok
Park Jeong-Woo
Bae Eun-Hui
Ma Seong-Kwon
Kim Nam-Ho
Jeong Myung-Ho
Kim Soo-Wan
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Abstract
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Purpose: This study aimed to compare the incidence and clinical significance of transient versus persistent acute kidney injury (AKI) on acute ST elevation myocardial infarction (STEMI).
Materials and Methods: The study was a retrospective cohort of 855 patients with STEMI. AKI was defined as an increase of ≥0.3 mg/dL in creatinine level at any point during hospital stay. The study population was classified into 5 groups: 1) patients without AKI; 2) patients with mild AKI that was resolved by discharge (creatinine change less than 0.5mg/dL compared with admission creatinine during hospital stay, transient mild AKI); 3) patients with mild AKI that did not resolve by discharge (persistent mild AKI); 4) patients with moderate/severe AKI that was resolved by discharge (creatinine change more than 0.5 mg/dL compared with admission creatinine, transient moderate/severe AKI); 5) patients with moderate/severe AKI that did not resolve by discharge (persistent moderate/severe AKI). We investigated 1-year all-cause mortality after hospital discharge for the primary outcome of the study. The relation between AKI and 1-year mortality after STEMI was analyzed.
Results: AKI occurred in 74 (8.7%) patients during hospital stay. Adjusted hazard ratio for mortality was 3.139 (95% CI 0.764 to 12.897, p=0.113) in patients with transient, mild AKI, and 8.885 (95% CI 2.710 to 29.128, p<0.001) in patients with transient, moderate/severe AKI compared to patients without AKI. Persistent moderate/severe AKI was also independent predictor of 1 year mortality (hazard ratio, 5.885; 95% CI 1.079 to 32.101, p=0.041).
Conclusion: Transient and persistent moderate/severe AKI during acute myocardial infarction is strongly related to 1-year all cause mortality after STEMI.
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KEYWORD
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Acute kidney injury, myocardial infarction, mortality
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