Zhang Xin-Ying, Fan Zhong-Guo, Xu Hai-Mei, Xu Ke, Tian Nai-Liang
Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, Jiangsu, China.
Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, 210006 Nanjing, Jiangsu, China.
Rev Cardiovasc Med. 2023 Jun 12;24(6):172. doi: 10.31083/j.rcm2406172. eCollection 2023 Jun.
Acute kidney injury (AKI) is common after cardiac interventional procedures. The prevalence and clinical outcome of AKI in patients with acute myocardial infarction (AMI) after undergoing intra-aortic balloon pump (IABP) implantation remains unknown. The aim of this study was to investigate the incidence, risk factors, and prognosis of AKI in specific patient populations.
We retrospectively reviewed 319 patients with AMI between January 2017 and December 2021 and who had successfully received IABP implantation. The diagnostic and staging criteria used for AKI were based on guidelines from "Kidney Disease Improving Global Outcomes". The composite endpoint included all-cause mortality, recurrent myocardial infarction, rehospitalization for heart failure, and target vessel revascularization.
A total of 139 patients (43.6%) developed AKI after receiving IABP implantation. These patients showed a higher incidence of major adverse cardiovascular events (hazard ratio [HR]: 1.55, 95% confidence interval [CI]: 1.06-2.26, = 0.022) and an increased risk of all-cause mortality (HR: 1.62, 95% CI: 1.07-2.44, = 0.019). Multivariable regression models found that antibiotic use (odds ratio [OR]: 2.07, 95% CI: 1.14-3.74, = 0.016), duration of IABP use (OR: 1.24, 95% CI: 1.11-1.39, 0.001) and initial serum creatinine (SCr) (OR: 1.01, 95% CI: 1.0-1.01, = 0.01) were independent risk factors for AKI, whereas emergency percutaneous coronary intervention was a protective factor (OR: 0.35, 95% CI: 0.18-0.69, = 0.003).
AMI patients who received IABP implantation are at high risk of AKI. Close monitoring of these patients is critical, including the assessment of renal function before and after IABP implantation. Additional preventive measures are needed to reduce the risk of AKI in these patients.
急性肾损伤（AKI）在心脏介入手术后很常见。急性心肌梗死（AMI）患者在接受主动脉内球囊反搏（IABP）植入术后AKI的患病率和临床结局仍不清楚。本研究的目的是调查特定患者群体中AKI的发生率、危险因素和预后。
我们回顾性分析了2017年1月至2021年12月期间319例成功接受IABP植入术的AMI患者。AKI的诊断和分期标准基于“改善全球肾脏病预后组织”的指南。复合终点包括全因死亡率、复发性心肌梗死、因心力衰竭再次住院以及靶血管血运重建。
共有139例患者（43.6%）在接受IABP植入术后发生AKI。这些患者发生主要不良心血管事件的发生率更高（风险比[HR]：1.55，95%置信区间[CI]：1.06 - 2.26，P = 0.022），全因死亡率风险增加（HR：1.62，95% CI：1.07 - 2.44，P = 0.019）。多变量回归模型发现，使用抗生素（比值比[OR]：2.07，95% CI：1.14 - 3.74，P = 0.016）、IABP使用时间（OR：1.24，95% CI：1.11 - 1.39，P < 0.001）和初始血清肌酐（SCr）（OR：1.01，95% CI：1.0 - 1.01，P = 0.01）是AKI的独立危险因素，而急诊经皮冠状动脉介入治疗是一个保护因素（OR：0.35，95% CI：0.18 - 0.69，P = 0.003）。
接受IABP植入术的AMI患者发生AKI的风险很高。对这些患者进行密切监测至关重要，包括在IABP植入术前和术后评估肾功能。需要采取额外的预防措施来降低这些患者发生AKI的风险。
