title: Renal replacement therapy in patients with acute myocardial infarction: Rate of use, clinical predictors and relationship with in-hospital mortality.
abstract: OBJECTIVE
  We evaluated the rate of use, clinical predictors, and in-hospital outcome of renal replacement therapy (RRT) in acute myocardial infarction (AMI) patients.
  
  
  METHODS
  All consecutive AMI patients admitted to the Coronary Care Unit between January 1st, 2005 and December 31st, 2015 were identified through a search of our prospectively collected clinical database. Patients were grouped according to whether they required RRT or not.
  
  
  RESULTS
  Two-thousand-eight-hundred-thirty-nine AMI patients were included. Eighty-three (3%) AMI patients underwent RRT. Variables confirmed at cross validation analysis to be associated with RRT were: admission creatinine >1.5mg/dl (OR 16.9, 95% CI 10.4-27.3), cardiogenic shock (OR 23.0, 95% CI 14.4-36.8), atrial fibrillation (OR 8.6, 95% CI 5.5-13.4), mechanical ventilation (OR 22.6, 95% CI 14.2-36.0), diabetes mellitus (OR 4.8, 95% CI 3.1-7.4), and left ventricular ejection fraction <40% (OR 9.1, 95% CI 5.6-14.7). The AUC for RRT with the combination of these predictors was 0.96 (95% CI 0.94-0.97; P<0.001). In-hospital mortality was significantly higher in RRT patients (41% vs. 2.1%, P<0.001). Oligoanuria as indication for RRT (OR 5.1, 95% CI 1.7-15.4), atrial fibrillation (OR 4.3, 95% CI 1.6-11.5), mechanical ventilation (OR 20.8, 95% CI 6.1-70.4), and cardiogenic shock (OR 12.9, 95% CI 4.4-38.3) independently predicted mortality in RRT-treated patients. The AUC for in-hospital mortality prediction with the combination of these variables was 0.92 (95% CI 0.87-0.98; P<0.001).
  
  
  CONCLUSIONS
  Patients with AMI undergoing RRT had strikingly high in-hospital mortality. Use of RRT and its associated mortality were accurately predicted by easily obtainable clinical variables.
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: giancarlo.marenzi@ccfm.it.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Marenzi
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cosentino
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marinetti
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Leone
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Milazzo
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Rubino
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: De Metrio
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Cabiati
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Jeness
authors.initials: J
authors.lastname: Campodonico
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Moltrasio
authors.affiliation: Nephrology and Dialysis Unit, Multimedica, I.R.C.C.S., Sesto San Giovanni, Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Bertoli
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Cecere
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Mosca
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Ivana
authors.initials: I
authors.lastname: Marana
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Grazi
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Lauri
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Bonomi
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D000072658:Non-ST Elevated Myocardial Infarction / Q000150:complications* / Q000401:mortality; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000150:complications* / Q000401:mortality; D012770:Shock, Cardiogenic / Q000150:complications* / Q000401:mortality; D015996:Survival Rate / Q000639:trends
keywords: Acute kidney injury; Acute myocardial infarction; In-hospital mortality; Renal replacement therapy