Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Eur Heart J Acute Cardiovasc Care. 2020 Oct;9(7):684-689. doi: 10.1177/2048872618808456. Epub 2018 Oct 17.
Acute kidney injury (AKI) is a frequent complication in patients with ST segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). While AKI occurring post-PCI has been well studied, the incidence and clinical significance of early renal impairment evident on hospital admission prior to PCI and which resolves towards discharge has not been investigated.
We retrospectively studied 2339 STEMI patients treated with primary PCI. The incidence of renal impairment and in-hospital complications as well as short and long-term mortality were compared between patients who did not develop renal impairment, patients who developed post-PCI AKI and those who presented with renal impairment on admission but improved their renal function during hospitalization (improved renal function). Improved renal function was defined as continuous and gradual decrease of ⩾ 0.3 mg/dL in serum creatinine levels obtained at hospital admission.
One hundred and nineteen patients (5%) had improved renal function and 230 patients (10%) developed post-PCI AKI. When compared with patients with no renal impairment, improved renal function and post-PCI AKI were associated with more complications and adverse events during hospitalization as well as higher 30-day mortality. Long-term mortality was significantly higher among those with post-PCI AKI (63/230, 27%) following STEMI than those without renal impairment (104/1990, 5%; <0.001), but there was no significant difference in long term mortality between patients with no renal impairment and those with improved renal function (5% . 7.5%, =0.17).
In STEMI patients undergoing primary PCI, the presence of renal impairment prior to PCI which resolves towards discharge is not uncommon and is associated with adverse short-term outcomes but better long-term outcomes compared with post-PCI AKI.
急性肾损伤（AKI）是经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者的常见并发症。虽然已经对 PCI 后发生的 AKI 进行了充分研究，但在 PCI 前入院时即存在并在出院时得到缓解的早期肾功能损害的发生率和临床意义尚未得到研究。
我们回顾性研究了 2339 例接受直接 PCI 治疗的 STEMI 患者。比较了未发生肾功能损害的患者、发生 PCI 后 AKI 的患者以及入院时存在肾功能损害但住院期间肾功能改善（肾功能改善）的患者之间的肾功能损害发生率和住院期间并发症以及短期和长期死亡率。肾功能改善定义为在入院时获得的血清肌酐水平连续且逐渐下降 ⩾ 0.3mg/dL。
119 例（5%）患者出现肾功能改善，230 例（10%）患者发生 PCI 后 AKI。与无肾功能损害的患者相比，肾功能改善和 PCI 后 AKI 与住院期间更多并发症和不良事件以及更高的 30 天死亡率相关。与无肾功能损害的患者相比（5%，104/1990），STEMI 后发生 PCI 后 AKI 的患者（63/230，27%）的长期死亡率显著更高（<0.001），但无肾功能损害的患者与肾功能改善的患者之间的长期死亡率无显著差异（5%，7.5%，=0.17）。
在接受直接 PCI 的 STEMI 患者中，PCI 前存在并在出院时得到缓解的肾功能损害并不少见，与不良的短期结局相关，但与 PCI 后 AKI 相比，长期结局更好。
