Impact of Acute Kidney Injury on In-Hospital Outcomes of Patients With Acute Myocardial Infarction　- Results From the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) Substudy.
Acute kidney injury (AKI) is associated with poor outcome after acute myocardial infarction (AMI), but whether hemodynamic status at presentation influences this prognostic significance is unknown.



A total of 2,798 AMI patients admitted within 48 h after symptom onset and who underwent urgent coronary angiography were enrolled in the present study. AKI was defined as an increase in serum creatinine ≥0.3 mg/dL or ≥50% within 48 h during hospitalization. Patients were classified into 3 groups according to Killip class on admission: Killip 1, n=2,164; Killip 2-3, n=366; and Killip 4, n=268. AKI occurred more frequently with increasing Killip class (Killip 1, 2-3, and 4: 6.3%, 15.3%, and 31.3%, respectively; P<0.001). AKI was associated with increased in-hospital mortality, regardless of Killip class (non-AKI and AKI patients: 1.1% vs. 6.6% in Killip 1; 5.2% vs. 35.7% in Killip 2-3, and 28.8% vs. 45.2% in Killip 4, P<0.01 for all). On multivariate analysis, the adjusted OR of AKI for in-hospital mortality in Killip 1, Killip 2-3, and Killip 4 were 3.79 (95% CI: 1.54-9.33, P=0.004), 5.35 (95% CI: 2.67-10.7, P<0.001), and 1.48 (95% CI: 0.94-2.35, P=0.093), respectively.



In AMI patients undergoing urgent coronary angiography, AKI was significantly associated with increased in-hospital mortality in Killip 1 as well as Killip 2-3 at presentation, but not in Killip 4.
Division of Cardiology, Yokohama City University Medical Center.
Shotaro
S
Kuji
Division of Cardiology, Yokohama City University Medical Center.
Masami
M
Kosuge
Division of Cardiology, Yokohama City University Medical Center.
Kazuo
K
Kimura
Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center.
Koichi
K
Nakao
Department of Cardiology, Fujita Health University.
Yukio
Y
Ozaki
Department of Cardiovascular Medicine, Kitasato University Hospital.
Junya
J
Ako
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center.
Teruo
T
Noguchi
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center.
Satoshi
S
Yasuda
Department of Cardiology, Juntendo University Shizuoka Hospital.
Satoru
S
Suwa
Department of Cardiology, National Hospital Organization Kumamoto Medical Center.
Kazuteru
K
Fujimoto
Department of Cardiology, Hiroshima City Hospital.
Yasuharu
Y
Nakama
Division of Cardiology, Osaka General Medical Center.
Takashi
T
Morita
Department of Cardiovascular Medicine, Nippon Medical School Hospital.
Wataru
W
Shimizu
First Department of Internal Medicine, Nara Medical University.
Yoshihiko
Y
Saito
Department of Cardiology, The Sakakibara Heart Institute of Okayama.
Atsushi
A
Hirohata
Department of Cardiology, Ogaki Municipal Hospital.
Yasuhiro
Y
Morita
Department of Cardiovascular Medicine, Dokkyo Medical University.
Teruo
T
Inoue
Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.
Kunihiro
K
Nishimura
Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.
Yoshihiro
Y
Miyamoto
Division of Coronary Artery Disease, Hyogo College of Medicine.
Masaharu
M
Ishihara
D058186:Acute Kidney Injury / Q000150:complications / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007564:Japan; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment
Myocardial infarction; Prognosis; Renal function