title: Acute kidney injury in acute coronary syndromes - An important multifactorial consequence.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a pathological phenomenon with a negative impact on outcomes in different clinical scenarios. Its mechanism in acute coronary syndrome (ACS) is not completely understood, and measures to prevent it are not uniform. We set out to study the incidence, clinical relevance, predictors and possible implications for patient management of AKI in ACS.
  
  
  METHODS
  Using data from a multicenter national registry on ACS, we retrospectively analyzed predictors of AKI and its impact on outcomes (in-hospital complications and one-year mortality). All ACS types were included. AKI was defined as an increase in serum creatinine of ≥0.3 mg/dl (≥26.4 μmol/l) and/or by ≥1.5 times baseline.
  
  
  RESULTS
  A total of 7808 ACS patients were included in the analysis, 1369 (17.5%) of whom developed AKI. AKI was shown to be an independent predictor of in-hospital major bleeding (odds ratio [OR] 2.09; 95% confidence interval [CI] 1.19-3.64; p=0.01), mortality (OR 4.72; 95% CI 2.94-7.56; p<0.001) and one-year mortality (hazard ratio 2.01; 95% CI 1.51-2.68; p<0.001). The incidence of AKI was associated with older age, history of hypertension, renal failure and stroke/transient ischemic attack, Killip class >1 on admission and left ventricular ejection fraction <50%. Performance of coronary angiography or angioplasty were not associated with AKI. Diuretics during admission were predictors of AKI only in patients in Killip class 1.
  
  
  CONCLUSIONS
  AKI is an important finding in ACS, with a significant impact on hard clinical endpoints such as in-hospital and one-year mortality. It is associated with easily identifiable clinical factors and an invasive strategy does not increase its incidence.
authors.affiliation: Cardiology Department, Hospital Espírito Santo, Évora, Portugal. Electronic address: dcneves25@hotmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Neves
authors.affiliation: Biostatistics Department, Portuguese Society of Cardiology, Lisbon, Portugal.
authors.forename: Adriana
authors.initials: A
authors.lastname: Belo
authors.affiliation: Cardiology Department, Hospital Espírito Santo, Évora, Portugal.
authors.forename: Ana Filipa
authors.initials: AF
authors.lastname: Damásio
authors.affiliation: Cardiology Department, Hospital Espírito Santo, Évora, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Carvalho
authors.affiliation: Cardiology Department, Hospital Espírito Santo, Évora, Portugal.
authors.forename: Ana Rita
authors.initials: AR
authors.lastname: Santos
authors.affiliation: Cardiology Department, Hospital Espírito Santo, Évora, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Piçarra
authors.affiliation: Cardiology Department, Hospital Espírito Santo, Évora, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Aguiar
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000453:epidemiology; D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000368:Aged; D017023:Coronary Angiography / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D011174:Portugal / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Acute coronary syndrome; Acute kidney injury; Angioplastia coronária; Contrast media; Coronariografia; Coronary angiography; Lesão renal aguda; Meios de contraste; Percutaneous coronary intervention; Síndrome coronária aguda