title: Heart failure is the strongest predictor of acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.
abstract: BACKGROUND
  ST elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PCI) are at higher risk of acute kidney injury (AKI) than patients undergoing PCI in stable clinical conditions. This fact suggests that mechanisms other than contrast nephrotoxicity are involved.
  
  
  OBJECTIVE
  To evaluate the incidence, risk factors, and consequences of AKI in patients undergoing primary PCI for STEMI in current daily practice.
  
  
  METHODS
  Analysis of all consecutive patients who underwent primary PCI over a one-year period. AKI was defined as an increase in serum creatinine ≥ 50% or 26.5 μmol/L (AKIN criteria) from the baseline within 48 h.
  
  
  RESULTS
  A total of 202 patients were included. AKI occurred in 25 (12.4%) subjects. Baseline characteristics and in-hospital complications of the patients with and without AKI did not differ significantly except for age (69 ± 13 vs. 62 ± 12; p = 0.003), female gender (48.0% vs. 26.6%; p = 0.035), hypertension (88.0% vs. 62.7%; p = 0.013), left ventricular ejection fraction (40% ± 12% vs. 49% ± 14%; p = 0.002), cardiogenic shock (44.0% vs. 5.1%; p < 0.0001), use of intravenous diuretics (76.0% vs. 26.0%; p < 0.0001), ventricular arrhythmias (24.0% vs. 3.4%; p = 0.001), and in-hospital mortality (24.0% vs. 3.4%; p = 0.001). In multivariate analysis heart failure remained the only independent correlate of AKI.
  
  
  CONCLUSIONS
  AKI was an frequent and serious complication of STEMI in patients treated by primary PCI. Heart failure was the strongest predictor of AKI. Other risk factors including contrast medium volume, baseline renal function, diabetes, and age failed to predict AKI.
authors.affiliation: Cardiology Centre AGEL, Pardubice, Czech Republic Department of Cardiology, Regional Hospital Pardubice, Czech Republic Faculty of Health Studies, University of Pardubice, Czech Republic. matejcata@gmail.com.
authors.forename: Jan
authors.initials: J
authors.lastname: Matějka
authors.forename: Ivo
authors.initials: I
authors.lastname: Varvařovský
authors.forename: Vladimír
authors.initials: V
authors.lastname: Rozsíval
authors.forename: Aleš
authors.initials: A
authors.lastname: Herman
authors.forename: Karel
authors.initials: K
authors.lastname: Bláha
authors.forename: Jan
authors.initials: J
authors.lastname: Večeřa
authors.forename: Tomáš
authors.initials: T
authors.lastname: Lazarák
authors.forename: Vojtěch
authors.initials: V
authors.lastname: Novotný
authors.forename: Vladimíra
authors.initials: V
authors.lastname: Mužáková
authors.forename: Petr
authors.initials: P
authors.lastname: Vojtíšek
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D006333:Heart Failure; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000601:surgery*
chemical_list: D003287:Contrast Media