Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission.
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).


METHODS
Prospective study.


METHODS
Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center.


METHODS
Ninety-seven consecutive STEMI patients with CS at admission, undergoing intra-aortic balloon pump (IABP) support and primary percutaneous coronary intervention (PCI).


METHODS
None.


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.
Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Cardiology of the University of Milan, Milan, Italy. giancarlo.marenzi@ccfm.it
Giancarlo
G
Marenzi
Emilio
E
Assanelli
Jeness
J
Campodonico
Monica
M
De Metrio
Gianfranco
G
Lauri
Ivana
I
Marana
Marco
M
Moltrasio
Mara
M
Rubino
Fabrizio
F
Veglia
Piero
P
Montorsi
Antonio L
AL
Bartorelli
D058186:Acute Kidney Injury / Q000150:complications* / Q000401:mortality; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D012306:Risk; D012770:Shock, Cardiogenic / Q000150:complications* / Q000401:mortality; D016896:Treatment Outcome
D003404:Creatinine