Prognostic significance of acute kidney injury after reperfused ST-elevation myocardial infarction: synergistic acceleration of renal dysfunction and left ventricular remodeling.
BACKGROUND
Acute kidney injury (AKI) after myocardial infarction is associated with poor clinical outcome. However, mechanisms of the adverse effect of AKI on clinical outcome after reperfused ST-elevation myocardial infarction (STEMI) have not been fully elucidated.


RESULTS
We examined 141 consecutive patients with reperfused first anterior STEMI. AKI was defined as an increase in serum creatinine of >or=0.3mg/dL within 48hours after admission. Patients with AKI had higher incidence of in-hospital cardiac death (P=.0004) and major adverse cardiac events (MACE, P=.020) during a mean of 39+/-40 (range, 1 to 96) months than those without, in association with adverse left ventricular (LV) remodeling. White blood cell count on admission and peak C-reactive protein were higher in patients with than those without AKI. Plasma norepinephrine on admission, interleukin-6, brain natriuretic peptide, and malondialdehyde-modified low-density lipoprotein 2 weeks after STEMI were higher in patients with AKI than those without AKI. Cox proportional hazards model analysis revealed AKI was an independent predictor of MACE (hazard ratio=2.38, P=.019).


CONCLUSIONS
AKI was a strong predictor of MACE in association with adverse LV remodeling. Enhanced inflammatory response, oxidative stress, and neurohormonal activation may synergistically accelerate renal dysfunction and LV remodeling after STEMI.
Anzai
Atsushi
A
Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Anzai
Toshihisa
T
Naito
Kotaro
K
Kaneko
Hidehiro
H
Mano
Yoshinori
Y
Jo
Yusuke
Y
Nagatomo
Yuji
Y
Maekawa
Yuichiro
Y
Kawamura
Akio
A
Yoshikawa
Tsutomu
T
Ogawa
Satoshi
S
D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein; D008078:Cholesterol, LDL; D003404:Creatinine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000473:pathology; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007564:Japan; D016015:Logistic Models; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000150:complications*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009638:Norepinephrine / Q000097:blood; D018384:Oxidative Stress; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000473:pathology; D020257:Ventricular Remodeling
D008078:Cholesterol, LDL; D015850:Interleukin-6; D020097:Natriuretic Peptide, Brain; D008315:Malondialdehyde; D002097:C-Reactive Protein; D003404:Creatinine; D009638:Norepinephrine