Archives of the Turkish Society of Cardiology
Effect of acute kidney injury on long-term mortality in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock who underwent primary percutaneous coronary intervention in a high-volume tertiary center [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2020; 48(1): 1-9 | DOI: 10.5543/tkda.2019.84401

Effect of acute kidney injury on long-term mortality in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock who underwent primary percutaneous coronary intervention in a high-volume tertiary center

Mert İlker Hayıroğlu1, Emrah Bozbeyoglu1, Özlem Yıldırımtürk1, Ahmet İlker Tekkeşin1, Seçkin Pehlivanoğlu2
1Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
2Department of Cardiology, Başkent University Faculty of Medicine, İstanbul, Turkey


OBJECTIVE
Acute kidney injury (AKI) is a reflection of both renal and cardiac reserve in patients with ST-segment elevation myocardial infarction (STEMI), but there is a lack of evidence related to the effect of AKI on long-term mortality in patients with STEMI. This study was an investigation of the prognostic value of AKI for long-term mortality in patients with STEMI complicated by cardiogenic shock (CS) and primary percutaneous coronary intervention (PPCI).

METHODS
This retrospective analysis evaluated the long-term prognostic impact of AKI on 492 patients with STEMI complicated by CS who were treated with PPCI. AKI was defined as ≥0.3mg/dL increase in serum creatinine within 48 hours or a ≥50% increase in serum creatinine in 7 days, or a reduction in urine output (documented oliguria of less than 0.5mL/kg per hour >6 hours. Patients were grouped according to the incidence of AKI and long-term mortality was compared. Cox regression analysis was used to determine independent prognostic factors of long-term mortality.

RESULTS
In Cox regression analysis, the age- and sex- adjusted hazard ratios (HRs) were higher for all-cause mortality in patients with AKI. [HR: 4.556; 95% confidence interval: (CI) 2.370–8.759]. After adjustment for confounding variables, the relative risk was greater for patients with AKI in comparison with patients without AKI (HR: 2.207; 95% CI: 1.150–4.739). Age (HR: 1.060, 95% CI: 1.027–1.094; p<0.001), left ventricular ejection fraction (HR: 0.952, 95% CI: 0.916–0.989; p=0.012), blood urea nitrogen level (HR: 1.019, 95% CI: 1.005–1.034; p=0.010), and AKI (HR: 2.244, 95% CI: 1.077–4.676; p=0.031) were found to be independent factors to determine long-term mortality.

CONCLUSION
The results of this study demonstrated that AKI was an independent prognostic factor for long-term mortality among patients with STEMI complicated by CS and treated with PPCI.

Keywords: Acute kidney injury, cardiogenic shock, myocardial infarction.

How to cite this article
Mert İlker Hayıroğlu, Emrah Bozbeyoglu, Özlem Yıldırımtürk, Ahmet İlker Tekkeşin, Seçkin Pehlivanoğlu. Effect of acute kidney injury on long-term mortality in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock who underwent primary percutaneous coronary intervention in a high-volume tertiary center. Turk Kardiyol Dern Ars. 2020; 48(1): 1-9

Corresponding Author: Mert İlker Hayıroğlu, Türkiye
© Copyright 2020 Archives of the Turkish Society of Cardiology
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