title: Acute Kidney Injury Definition and In-Hospital Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction.
abstract: Acute kidney injury (AKI) has been associated with increased mortality in ST-segment elevation myocardial infarction. We compared the mortality predictive accuracy of the 3 AKI definitions used most widely for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
  
  
  
  We included 3771 patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention at 2 Italian hospitals. AKI incidence was evaluated according to creatinine increases of ≥25% (AKI-25), ≥0.3 mg/dL (AKI-0.3), and ≥0.5 mg/dL (AKI-0.5). The primary end point was in-hospital mortality. Overall, 557 (15%), 522 (14%), and 270 (7%) patients developed AKI-25, AKI-0.3, and AKI-0.5, respectively (P<0.01). All AKI definitions independently predicted in-hospital mortality (adjusted odds ratio 4.9 [95% CI 3.1-7.8], 5.4 [95% CI 3.3-8.6], and 8.3 [95% CI 5.1-13.3], respectively; P<0.01 for all). At receiver operating characteristic analysis, the addition of each AKI definition to combined clinical predictors of mortality (age, sex, left ventricular ejection fraction, admission creatinine, creatine kinase-MB peak) found at stepwise analysis significantly improved mortality prognostication (area under the curve increased from 0.89 for clinical predictor combination alone to 0.92 for AKI-25, 0.92 for AKI-0.3, and 0.93 for AKI-0.5; P<0.01 for all). At reclassification analysis, AKI-0.5 added to clinical predictors, provided the highest score in mortality (net reclassification improvement +10% versus AKI-0.3 [P=0.01] and +8% versus AKI-25 [P=0.05]).
  
  
  
  Each AKI definition significantly improved the mortality prediction beyond major clinical variables. AKI-0.5 showed a mortality discrimination advantage, suggesting it should be the preferred definition in studies addressing ST-segment elevation myocardial infarction and focusing on short-term mortality.
authors.affiliation: Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy giancarlo.marenzi@ccfm.it.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Marenzi
authors.affiliation: Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cosentino
authors.affiliation: Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Moltrasio
authors.affiliation: Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Rubino
authors.affiliation: Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Crimi
authors.affiliation: Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Buratti
authors.affiliation: Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Grazi
authors.affiliation: Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Milazzo
authors.affiliation: Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy Department of Molecular Medicine, University of Pavia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Somaschini
authors.affiliation: Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Camporotondo
authors.affiliation: Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy Department of Molecular Medicine, University of Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cornara
authors.affiliation: Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: De Metrio
authors.affiliation: Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Bonomi
authors.affiliation: Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.affiliation: Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy Department of Molecular Medicine, University of Pavia, Italy.
authors.forename: Gaetano M
authors.initials: GM
authors.lastname: De Ferrari
authors.affiliation: Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D012372:ROC Curve; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000601:surgery*
keywords: acute kidney injury; serum creatinine concentration