Critical care medicine · 2010
Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Marenzi Giancarlo, Assanelli Emilio, Campodonico Jeness, De Metrio Monica, Lauri Gianfranco, Marana Ivana, Moltrasio Marco, Rubino Mara, Veglia Fabrizio, Montorsi Piero, Bartorelli Antonio L
Аннотация
OBJECTIVE: To evaluate the clinical and prognostic relevance of acute kidney injury (AKI) in the setting of ST-elevation acute myocardial infarction (STEMI) complicated by cardiogenic shock (CS).
DESIGN: Prospective study.
SETTING: Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center.
PATIENTS: Ninety-seven consecutive STEMI patients with CS at admission, undergoing intra-aortic balloon pump (IABP) support and primary percutaneous coronary intervention (PCI).
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: We measured serum creatinine at baseline and each day for the following 3 days. Acute kidney injury was defined as a rise in creatinine >25% from baseline. Overall, AKI occurred in 52 (55%) patients, and in 12 of these patients, a renal replacement therapy was required. In multivariate analysis, age >75 yrs (p = .005), left ventricular ejection fraction < or = 40% (p = .009), and use of mechanical ventilation (p = .01) were independent predictors of AKI. Patients developing AKI had a longer hospital stay, a more complicated clinical course, and significantly higher mortality rate (50% vs. 2.2%; p <.001) than patients without AKI. In our population, AKI was the strongest independent predictor of in-hospital mortality (relative risk 12.3, 95% confidence intervals 1.78 to 84.9; p <.001).
CONCLUSIONS: In patients with STEMI complicated by CS, AKI represents a frequent clinical complication associated with a poor prognosis.
DESIGN: Prospective study.
SETTING: Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center.
PATIENTS: Ninety-seven consecutive STEMI patients with CS at admission, undergoing intra-aortic balloon pump (IABP) support and primary percutaneous coronary intervention (PCI).
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: We measured serum creatinine at baseline and each day for the following 3 days. Acute kidney injury was defined as a rise in creatinine >25% from baseline. Overall, AKI occurred in 52 (55%) patients, and in 12 of these patients, a renal replacement therapy was required. In multivariate analysis, age >75 yrs (p = .005), left ventricular ejection fraction < or = 40% (p = .009), and use of mechanical ventilation (p = .01) were independent predictors of AKI. Patients developing AKI had a longer hospital stay, a more complicated clinical course, and significantly higher mortality rate (50% vs. 2.2%; p <.001) than patients without AKI. In our population, AKI was the strongest independent predictor of in-hospital mortality (relative risk 12.3, 95% confidence intervals 1.78 to 84.9; p <.001).
CONCLUSIONS: In patients with STEMI complicated by CS, AKI represents a frequent clinical complication associated with a poor prognosis.