The Canadian journal of cardiology · 2026
High Kidney Function in Myocardial Infarction Patients Who Underwent Coronary Intervention: Acute Kidney Injury Risk and Long-term Prognosis.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Wu Shuo, Wang Shikun, Xu Feng, Pang Jiaojiao, Chen Yuguo
Аннотация
BACKGROUND: Acute kidney injury (AKI) is a critical complication in ST-segment elevation myocardial infarction (STEMI) patients who undergo percutaneous coronary intervention (PCI). The effect of high preoperative estimated glomerular filtration rate (eGFR; ≥ 105 mL/min/1.73 m2) on AKI and long-term adverse outcomes remains poorly understood.
METHODS: In this multicentre, prospective cohort study we enrolled 4536 STEMI consecutive patients who underwent emergency PCI in China. Logistic regression was used to assess the association between preoperative eGFR and AKI, and Cox regression was used to evaluate the effect of preoperative eGFR and AKI on 2-year adverse outcomes.
RESULTS: Among 4536 patients, 820 (18.1%) had high eGFR, 1806 (39.8%) normal eGFR (90-105 mL/min/1.73 m2), 1547 (34.1%) mild reduction of eGFR (60-90 mL/min/1.73 m2), and 363 (8.0%) had low eGFR (< 60 mL/min/1.73 m2). Mean age was 62 years; 23.2% were female. Low and high eGFR levels were independently associated with increased AKI risk (adjusted odds ratio, 1.818 [95% confidence interval (CI), 1.268-2.608] and 2.143 [95% CI, 1.517-3.025]). Two-year major adverse cardiovascular events incidence increased progressively with declining eGFR: 4.0% (high), 5.5% (normal), 11.3% (mild), and 22.3% (low). Among patients with normal-to-high eGFR, those with AKI had higher risks of major adverse cardiovascular events (hazard ratio, 2.418 [95% CI, 1.579-3.704]) and all-cause mortality (hazard ratio, 2.380 [95% CI, 1.407-4.025]).
CONCLUSIONS: This study confirmed a U-shaped relationship between preoperative eGFR and AKI, highlighting that high eGFR is an under-recognized risk factor for AKI and long-term adverse outcomes in STEMI patients. These findings underscore the need for enhanced clinical vigilance and tailored management strategies for PCI patients with high preoperative eGFR.
CLINICAL TRIAL REGISTRATION: NCT03510832.
METHODS: In this multicentre, prospective cohort study we enrolled 4536 STEMI consecutive patients who underwent emergency PCI in China. Logistic regression was used to assess the association between preoperative eGFR and AKI, and Cox regression was used to evaluate the effect of preoperative eGFR and AKI on 2-year adverse outcomes.
RESULTS: Among 4536 patients, 820 (18.1%) had high eGFR, 1806 (39.8%) normal eGFR (90-105 mL/min/1.73 m2), 1547 (34.1%) mild reduction of eGFR (60-90 mL/min/1.73 m2), and 363 (8.0%) had low eGFR (< 60 mL/min/1.73 m2). Mean age was 62 years; 23.2% were female. Low and high eGFR levels were independently associated with increased AKI risk (adjusted odds ratio, 1.818 [95% confidence interval (CI), 1.268-2.608] and 2.143 [95% CI, 1.517-3.025]). Two-year major adverse cardiovascular events incidence increased progressively with declining eGFR: 4.0% (high), 5.5% (normal), 11.3% (mild), and 22.3% (low). Among patients with normal-to-high eGFR, those with AKI had higher risks of major adverse cardiovascular events (hazard ratio, 2.418 [95% CI, 1.579-3.704]) and all-cause mortality (hazard ratio, 2.380 [95% CI, 1.407-4.025]).
CONCLUSIONS: This study confirmed a U-shaped relationship between preoperative eGFR and AKI, highlighting that high eGFR is an under-recognized risk factor for AKI and long-term adverse outcomes in STEMI patients. These findings underscore the need for enhanced clinical vigilance and tailored management strategies for PCI patients with high preoperative eGFR.
CLINICAL TRIAL REGISTRATION: NCT03510832.