1 Departments of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
2 Departments of Nephrology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Eur Heart J Acute Cardiovasc Care. 2018 Dec;7(8):732-738. doi: 10.1177/2048872617716389. Epub 2017 Jun 15.
: Acute kidney injury is associated with adverse outcomes after acute ST elevation myocardial infarction (STEMI). It remains unclear, however, whether subclinical increase in serum creatinine that does not reach the consensus criteria for acute kidney injury is also related to adverse outcomes in STEMI patients undergoing primary percutaneous coronary intervention.
: We conducted a retrospective study of 1897 consecutive STEMI patients between January 2008 and May 2016 who underwent primary percutaneous coronary intervention, and in whom acute kidney injury was not diagnosed throughout hospitalization. We investigated the incidence of subclinical acute kidney injury (defined as serum creatinine increase of ≥ 0.1 and < 0.3 mg/dl) and its relation to a composite end point of adverse in hospital outcomes.
: Subclinical acute kidney injury was detected in 321 patients (17%). Patients with subclinical acute kidney injury had increased rate of the composite end point of adverse in-hospital events (20.3% vs. 9.7%, p<0.001), a finding which was independent of baseline renal function. Individual components of this end point (occurrence of heart failure, atrial fibrillation, need for mechanical ventilation and in-hospital mortality) were all significantly higher among patients with subclinical acute kidney injury ( p< 0.05 for all). In a multivariable regression model subclinical acute kidney injury was independently associated with higher risk for adverse in-hospital events (odds ratio 1.92.6, 95% confidence interval: 1.23-2.97, p=0.004).
: Among STEMI patients treated with primary percutaneous coronary intervention, small, subclinical elevations of serum creatinine, while not fulfilling the consensus criteria for acute kidney injury, may serve as a significant biomarker for adverse outcomes.
急性肾损伤与急性 ST 段抬高型心肌梗死（STEMI）后的不良结局相关。然而，在接受直接经皮冠状动脉介入治疗的 STEMI 患者中，血清肌酐的亚临床升高（尚未达到急性肾损伤的共识标准）是否也与不良结局相关，目前尚不清楚。
我们对 2008 年 1 月至 2016 年 5 月期间连续 1897 例接受直接经皮冠状动脉介入治疗且住院期间未诊断为急性肾损伤的 STEMI 患者进行了回顾性研究。我们调查了亚临床急性肾损伤（定义为血清肌酐升高≥0.1 且<0.3mg/dl）的发生率及其与住院期间不良复合结局的关系。
321 例（17%）患者检测到亚临床急性肾损伤。亚临床急性肾损伤患者的不良住院事件复合终点发生率较高（20.3% vs. 9.7%，p<0.001），且这一发现独立于基线肾功能。该终点的各个组成部分（心力衰竭、心房颤动、需要机械通气和住院死亡率）在亚临床急性肾损伤患者中均显著更高（所有 p<0.05）。在多变量回归模型中，亚临床急性肾损伤与不良住院事件的高风险独立相关（比值比 1.92，95%置信区间：1.23-2.97，p=0.004）。
在接受直接经皮冠状动脉介入治疗的 STEMI 患者中，血清肌酐的小幅度、亚临床升高，即使未达到急性肾损伤的共识标准，也可能是不良结局的重要生物标志物。
