Yonsei Med J.  2011 Jul;52(4):603-609. 10.3349/ymj.2011.52.4.603.

Impact of Acute Kidney Injury on Clinical Outcomes after ST Elevation Acute Myocardial Infarction

• Kim MJ
• Choi HS
• Oh SH
• Lee HC
• Kim CS
• Choi JS
• Park JW
• Bae EH
• Ma SK
• Kim NH
• Jeong MH
• Kim SW

• KMID: 1727992
• DOI: http://doi.org/10.3349/ymj.2011.52.4.603

Abstract

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 > or =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.

Keyword

Acute kidney injury; myocardial infarction; mortality

MeSH Terms

Acute Kidney Injury/complications/diagnosis/*epidemiology
Aged
Creatinine/blood
Electrocardiography
Female
Humans
Incidence
Male
Middle Aged
Myocardial Infarction/*complications/diagnosis/mortality
Prognosis
Retrospective Studies

Figure

• 

  Fig. 1 Kaplan-Meier survival curves according to acute kidney injury categories. AKI, acute kidney injury.

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