High Incidence and Predictors of Acute Kidney Injury in Patients with STEMI Treated with Primary PCI

Background:
Contrast-induced acute kidney injury (CI-AKI) is associated with morbidity and mortality. Patients presenting with STEMI are rushed to the cath-lab and PCI without comprehensive assessment of the risk to develop CI-AKI.

Methods:
We retrospectively reviewed the medical records of all patients presenting with STEMI and treated with primary PCI during 1/2005-11/2016, including their baseline characteristics, procedural data, and renal function 48-72 hours post admission. The blood work that was taken at admission prior to the procedure was regarded as baseline levels. CI-AKI was defined as a rise of creatinine of ≥0.5 mg/dL or ≥25% as compared to baseline. Mortality data was extracted from the national census.

Results:
Complete data was available for 2079 consecutive pts. CI-AKI occurred in 531 (25.5%) patients. Multivariate analysis showed that independent predictors for development of CI-AKI included: older age (OR 1.02 p=0.002), female gender (OR 1.48 p=0.035), diabetes mellitus (OR 1.58, p=0.005), chronic renal failure (OR 2.38, p=0.037), atrial fibrillation (OR 2.25, p=0.01), contrast media volume (OR 1.41, p=0.019), and hemoglobin levels (OR 0.83, p<0.0001). Mortality at one year was 7.7%. CI-AKI was an independent predictor of mortality (OR 4.12, p<0.0001). Other predictors included older age (OR 1.08, p<0.0001), prior stroke (OR 2.52, p=0.047), elevated creatinine (OR 1.38, p<0.0001), WBC count (OR 1.15, p<0.0001) and HB level (OR 0.74, p<0.0001).

Conclusions:
The incidence of CI-AKI in patients with STEMI undergoing primary PCI is high and is associated with increased mortality. Special attention should be given to older patients, women, history of diabetes mellitus, chronic renal failure, anemia and atrial fibrillation at admission. Special strategy and prevention measures are needed in these patients that are at increased risk of CI-AKI.