Prognostic impact of acute kidney injury on one-year survival in patients undergoing high-risk PCI with Impella support.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Sacha J, Woitek F J, Pietrasik A, Laupp A, Gąsecka A, Conrad A, Pawłowski T, Obradovic D, Grygier M, Haussig S, Bielawski G, Mierke J, Balak W, Jellinghaus S, Sukiennik A, Burzyńska P, Witkowski A, Warniełło M, Rzeszutko Ł, Bartuś S, Pawlik A, Kaczyński M, Gil R, Kuliczkowski W, Reczuch K, Protasiewicz M, Kleczyński P, Wańczura P, Gurba S, Kochanowska A, Łomiak M, Skorupski W, Zarębiński M, Pawluczuk P, Włodarczak S, Włodarczak A, Ściborski K, Telichowski A, Pluciński M, Hiczkiewicz J, Konsek K, Hawranek M, Gąsior M, Peruga J, Fiutowski M, Romanek R, Kasprzyk P, Ciećwierz D, Ochała A, Wojakowski W, Legutko J, Linke A, Kochman J, Mangner N
Аннотация
This multicenter study evaluated the prognostic impact of acute kidney injury (AKI) on one-year survival in patients undergoing Impella-supported high-risk percutaneous coronary intervention (hrPCI), and whether Impella use offers renal protection. A total of 470 patients from two independent cohorts were analyzed: the IMPELLA-PL group (n = 249, derivation cohort) and the Dresden group (n = 221, validation cohort). Patients with cardiogenic shock or chronic dialysis were not included. AKI-defined as a ≥ 0.5 mg/dL increase in serum creatinine within 72 h-occurred in 13.3% and 14.9% of patients, respectively, which was significantly lower than the predicted 26.1% risk based on the Mehran Risk Score. AKI was an independent predictor of one-year mortality in both the derivation (HR: 2.75; 95% CI: 1.11-6.82) and validation (HR: 2.16; 95% CI: 1.12-4.10) cohorts. Upfront Impella implantation and higher baseline glomerular filtration rate were independently associated with a reduced risk of AKI in both cohorts. The adverse effect of AKI on long-term survival was significant in males, but not in females. These findings indicate that although AKI remains a strong prognostic marker following hrPCI, early Impella support may mitigate this risk. The results also suggest potential sex-related differences in susceptibility to renal complications following complex coronary interventions.