Time is kidney: relation between pain-to-balloon time and acute kidney injury among ST segment elevation myocardial infarction patients undergoing primary percutaneous intervention

Type of funding sources: None.

Among ST segment elevation myocardial infarction (STEMI) early hemodynamic changes may result in acute kidney injury (AKI) even prior to primary percutaneous coronary intervention (PCI), however, no information to date is present regarding the association between pain to balloon (PBT) and AKI.

We evaluated whether PBT predicts the risk of AKI among STEMI patients undergoing primary PCI.

Medical records of 2343 STEMI patients undergoing primary PCI were reviewed. Patients were stratified by PBT into 3 groups: ≤120, 121-360 and > 360 minutes. Patients' records were assessed for the occurrence of AKI (defined by the KDIGO criteria as serum creatinine elevation ≥ 0.3 mg/dl within 72 hours after admission).

Mean age was 61 ± 13 years and 1919 (82%) were male. Patients having longer PBT had more AKI complicating the course of STEMI (7 % vs. 8 % vs. 13 %, p<0.001) and had significantly higher serum creatinine changes throughout hospitalization (0.08 mg/dl vs. 0.11 mg/dl vs.0.17 mg/dl p<0.001). In a multivariable logistic regression model each 1-hour increase in PBT was independently associated with a 2.2% increase in risk for AKI (OR 1.022, 95% CI 1.01-1.04, p=0.02). In a second model, PBT >360 minutes turned out to be a strong an independent predictor for AKI occurrence (OR 1.6 ,95% CI 1.1-2.2, p=0.006, model 2). Other factors independently associated with AKI included age > 60 years, CKD, hypertension and left ventricular ejection fraction ≤ 45%.

Longer PBT may be an independent marker for the development of AKI in STEMI patients undergoing primary.