Time is kidney: Relation between pain-to-balloon time and acute kidney injury among ST-segment elevation myocardial infarction patients Undergoing Primary Percutaneous intervention

Background: At the time of ST-segment elevation myocardial infarction (STEMI) early hemodynamic changes may result in acute kidney injury (AKI), however no information to date is present regarding the association between pain-to-balloon time (PBT) and AKI. We evaluated whether PBT interval correlates with the risk for AKI among STEMI patients undergoing primary PCI.

Methods: Medical records of 2343 STEMI patients were reviewed. Patients` were stratified by PBT into 3 groups: ≤120, 121-360 and >360 minutes. Patients` records were assessed for the occurrence of AKI (defined by the KDIGO criteria as serum creatinine elevation ≥ 0.3 mg/dl within 72 hours after admission).

Results: Mean age was 61 ± 13 years and 1919 (82%) were male. Patients having longer time intervals from symptom onset to reperfusion showed a graded increase in risk for AKI complicating the course of STEMI (7 % vs. 8 % vs. 13 %, p<0.001) and had significantly higher serum creatinine changes throughout hospitalization (0.08 mg/dl vs. 0.11 mg/dl vs.0.17 mg/dl, p<0.001). In a multivariate binary logistic regression model, each 1-hour increase in PBT was independently associated with an average 2.2% increase in the risk of AKI [OR 1.022 (95% CI 1.003-1.041), p=0.02]. In a second multivariate model patients with PBT >360 minutes had an increase in risk for AKI of 58% [OR 1.58 (95%CI 1.14-2.19), p=0.006).

Conclusion: Longer PBT may be an independent marker for the development of AKI in STEMI patients undergoing primary PCI.