Journal Article

Prognostic Impact of Combined Contrast-Induced Acute Kidney Injury and Hypoxic Liver Injury in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Results from INTERSTELLAR Registry

Park, Hyun Woo, Moon, Jeonggeun, Suh, Jon, Kang, WoongChol, Jang, Ho-Jun, Shin, Sung-Hee, Woo, Seong-Il, Kim, Dae-Hyeok, Suh, Young Ju, Park, Sang-Don, Kwan, Jun, Kwon, Sung Woo, Oh, Pyung Chun, Kim, Tae-Hoon

2016

Overview

Besides contrast-induced acute kidney injury(CI-AKI), adscititious vital organ damage such as hypoxic liver injury(HLI) may affect the survival in patients with ST-elevation myocardial infarction (STEMI). We sought to evaluate the prognostic impact of CI-AKI and HLI in STEMI patients who underwent primary percutaneous coronary intervention (PCI). A total of 668 consecutive patients (77.2% male, mean age 61.3±13.3 years) from the INTERSTELLAR STEMI registry who underwent primary PCI were analyzed. CI-AKI was defined as an increase of ≥0.5 mg/dL in serum creatinine level or 25% relative increase, within 48h after the index procedure. HLI was defined as ≥2-fold increase in serum aspartate transaminase above the upper normal limit on admission. Patients were divided into four groups according to their CI-AKI and HLI states. Major adverse cardiovascular and cerebrovascular events (MACCE) defined as a composite of all-cause mortality, non-fatal MI, non-fatal stroke, ischemia-driven target lesion revascularization and target vessel revascularization were recorded. Over a mean follow-up period of 2.2±1.6 years, 94 MACCEs occurred with an event rate of 14.1%. The rates of MACCE and all-cause mortality were 9.7% and 5.2%, respectively, in the no organ damage group; 21.3% and 21.3% in CI-AKI group; 18.5% and 14.6% in HLI group; and 57.7% and 50.0% in combined CI-AKI and HLI group. Survival probability plots of composite MACCE and all-cause mortality revealed that the combined CI-AKI and HLI group was associated with the worst prognosis (p<0.0001 for both). Combined CI-AKI after index procedure and HLI on admission is associated with poor clinical outcomes in patients with STEMI who underwent primary PCI. (INTERSTELLAR ClinicalTrials.gov number, NCT02800421.).

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acute kidney failure / Acute Kidney Injury - diagnosis / Acute Kidney Injury - etiology / Acute Kidney Injury - mortality / Aged / Analysis / Angioplasty / Aspartate transaminase / Balloon angioplasty / Biology and Life Sciences / Cardiology / Cardiovascular disease / Cerebral infarction / Cerebrovascular system / Cholesterol / Creatinine / Development and progression / Diabetes / Female / Health aspects / Heart attacks / Heart failure / Hepatitis / Hospitals / Humans / Hypoxia / Hypoxia - diagnosis / Hypoxia - etiology / Hypoxia - mortality / Injuries / Intensive care / Interstellar / Intervention / Ischemia / Kidneys / Liver / Liver diseases / Liver Diseases - diagnosis / Liver Diseases - etiology / Liver Diseases - mortality / Male / Medical prognosis / Medicine and Health Sciences / Middle Aged / Mortality / Myocardial infarction / Patient outcomes / Patients / People and Places / Percutaneous Coronary Intervention - adverse effects / Prognosis / Proportional Hazards Models / Risk factors / ST Elevation Myocardial Infarction - complications / ST Elevation Myocardial Infarction - mortality / ST Elevation Myocardial Infarction - surgery / Survival / Survival Analysis / Thoracic surgery / Transaminase / Variance analysis