Acute kidney injury in patients with ST-elevation myocardial infarction after percutaneous coronary interventions

to determine the frequency and predictors of acute kidney injury (AKI) in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing urgent revascularization.

In a single-center, open-label study, 286 patients were included (mean age 62.8±9.8 years). Among the examined were 202 (70.6%) men and 84 (29.4%) women. 258 patients with STEMI were included in the analysis of the dynamics of the functional state of the kidneys. AKI was verified in case of an increase in creatinine level by >10% or more from the initial level. To determine independent predictors of AKI in patients with STEMI after PCI and assess the possibility of predicting such a complication, we used Fisher's multiple linear discriminant analysis.

An increase in the value of creatinine >10% from the initial level on the 3rd day of observation was registered in 93 (36.0%) patients. Indicators that demonstrated a statistically significant rank correlation (p<0.05) with the investigated clinical outcome were included in the subsequent discriminant analysis of independent predictors of AKI: advanced age of patients (60-74 years); presence of type 2 diabetes mellitus in the anamnesis; presence of AF in the anamnesis; AHF of III class according to Killip; body weight (kg); the stenosis of the distal segment of LAD; the size of the LA (mm); LV EF (%); serum creatinine level in μmol/l; GFR according to the formula CKD-EPI Cystatin C (CKD cystatin [ml/min/1.73 m2]); blood hemoglobin (g/l); C-reactive protein (mg/l); troponin I (ng/ml); urea (mmol/l); and the level of potassium in blood serum (mmol/l) on the 1st day of the study.

According to the results of the multiple linear discriminant analysis, the level of CKD cystatin turned out to be an independent predictor of AKI. The highest sensitivity of prediction is observed at the value of eGFR cystatin >72.8 ml/min/1.73 m2 (100%), while the specificity is at the value <60.5 ml/min/1.73 m2 (69.3%). It should be noted that the value of eGFR cystatin >66.7 ml/min/1.73 m2 determines the largest share of correct prediction results (diagnostic accuracy - 70.5%). So, taking into account the eGFR cystatin >66.7 ml/min/1.73 m2, calculated during hospitalization of a patient with STEMI (before PCI), it is possible to predict the development of AKI after the intervention with a sensitivity of 94.7% and a specificity of 68.2%. At the same time, to increase the sensitivity of diagnosis, it is possible to use the value of eGFR cystatin >72.8 ml/min/1.73 m2 (sensitivity of diagnosis 100%); however, specificity and diagnostic accuracy decrease (66.5% and 67.8%, respectively).

In patients with STEMI, the level of CKD cystatin C was found to be an independent predictor of AKI after urgent PCI. In clinical practice, the value of eGFR cystatin >66.7 ml/min/1.73 m2 determines the largest share of correct prediction results and can be used as a predictor of AKI.