Abstract
Acute kidney injury (AKI) frequently complicates ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) and islinked to increased short-term and long-term mortality. However, the impact of the AKI onset time following PCI on patient outcomes remains uncertain. This study aimed to investigate the timing of post-PCI AKI development and its prognostic significance in STEMI patients.
This retrospective cohort study included 2,912 STEMI patients who underwent successful PCI upon admission. The timing of AKI was determined according to the KDIGO (Kidney Disease Improving Global Outcomes) criteria, using routine blood tests conducted during the hospital stay. The primary endpoint was all-cause mortality.
Among 2,912 STEMI patients studied, 222 (7.6%) developed AKI. Based on ROC analysis, AKI was classified as early if it occurred within 1.5 days (n=108, 48.6%) or late if it occurred after 1.5 days (n=114, 51.4%,figure 1). Early AKI was associated with a significantly higher incidence of cardiogenic shock at presentation, a lower post-PCI left ventricular ejection fraction, and increased 30-day mortality compared to late AKI (p<0.01 for all). Mortality was significantly higher in the early AKI group ( hazard ratio 1.51, 95% confidence interval CI 1.07-2.13, p=0.019,figure 2). In multivariate Cox regression analysis, early AKI emerged as an independent predictor of long-term mortality (median follow-up of 4.7 years, adjusted HR 1.7, 95% CI 1.1-2.8, p=0.02). Multivariate logistic regression analysis identified cardiogenic shock as a significant predictor of early AKI (adjusted OR 2.3, 95% CI 1.1-4.9, p=0.03).
Author notes
Funding Acknowledgements: None.
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