Itach Tamar, Banai Ariel, Paran Yael, Zahler David, Merdler Ilan, Eliashiv David, Banai Shmuel, Shacham Yacov
Departments of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel.
Departments of Internal Medicine, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6423906, Israel.
J Clin Med. 2022 Apr 13;11(8):2169. doi: 10.3390/jcm11082169.
Background: Acute kidney injury (AKI) is a frequent complication in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Identification of different AKI recovery patterns may improve patient prognostic stratification. We investigated the clinical relevance of AKI recovery patterns among STEMI patients undergoing PCI. Methods: A retrospective study of 2943 STEMI patients undergoing PCI. The incidence of renal impairment, in-hospital complications, short and long-term mortality, were compared between patients without AKI, with early recovery defined as a return to baseline creatinine within 72 h, and no AKI recovery/delayed recovery defined as all other AKI cases. Results: A total of 255 (8.7%) patients developed AKI, of whom 124/255 (49%) patients had an early recovery, whereas 131/255 (51%) had no AKI recovery/delayed recovery. Patients without recovery were more likely to have in-hospital complications and higher long-term mortality (36.64% vs. 7.25%%; p < 0.001). In a multivariable regression model, the mortality hazard ratio (HR) for long term mortality remained significant for patients with no/delayed recovery AKI (HR 7.76, 95% CI 4.69 to 12.86, p < 0.001), and a strong trend among patients with resolving AKI (HR 2.09, 95% CI 0.933−4.687, p = 0.071). Conclusions: Among STEMI patients undergoing PCI, the recovery pattern of AKI is a valuable prognostic marker.
急性肾损伤（AKI）是接受经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者常见的并发症。识别不同的AKI恢复模式可能改善患者的预后分层。我们研究了接受PCI的STEMI患者中AKI恢复模式的临床相关性。方法：对2943例接受PCI的STEMI患者进行回顾性研究。比较无AKI患者、早期恢复（定义为72小时内血肌酐恢复至基线）患者以及无AKI恢复/延迟恢复（定义为所有其他AKI病例）患者的肾功能损害发生率、住院并发症、短期和长期死亡率。结果：共有255例（8.7%）患者发生AKI，其中124/255例（49%）患者早期恢复，而131/255例（51%）患者无AKI恢复/延迟恢复。未恢复的患者更易发生住院并发症且长期死亡率更高（36.64%对7.25%；p<0.001）。在多变量回归模型中，无/延迟恢复AKI的患者长期死亡的死亡率风险比（HR）仍然显著（HR 7.76，95%CI 4.69至12.86，p<0.001），而AKI缓解的患者有强烈趋势（HR 2.09，95%CI 0.933−4.687，p = 0.071）。结论：在接受PCI的STEMI患者中，AKI的恢复模式是一个有价值的预后标志物。
