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Impact of contrast-induced acute kidney injury with transient or persistent renal dysfunction on long-term outcomes of patients with acute myocardial infarction undergoing percutaneous coronary intervention
  1. Jin Wi1,
  2. Young-Guk Ko1,
  3. Jung-Sun Kim1,
  4. Byeong-Keuk Kim1,
  5. Donghoon Choi1,
  6. Jong-Won Ha1,
  7. Myeong-Ki Hong1,2,
  8. Yangsoo Jang1,2
  1. 1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
  2. 2Severance Biomedical Science Institute, Yonsei University Health System, Seoul, Republic of Korea
  1. Correspondence to Yangsoo Jang, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea, jangys1212{at}yuhs.ac

Abstract

Objective

Objective To investigate the long-term prognostic implications of contrast-induced acute kidney injury (CI-AKI) with transient or persistent renal dysfunction in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI).

Design

Design A retrospective observational registry study.

Setting

Setting Clinical follow-up after PCI.

Patients and Methods

Patients and Methods A total of 1041 PCI-treated AMI patients from the Infarction Prognosis Study registry. CI-AKI was defined as an increase in serum creatinine (>25% or >0.5 mg/dl (>44.2 μmol/l)) within 2 days after PCI.

Main Outcome Measures

Main Outcome Measures Two-year cumulative event rate of all-cause death or renal failure requiring dialysis.

Results

Results CI-AKI was observed in 148 patients (14.2%). Patients with CI-AKI had a higher rate of death or dialysis (25.4% vs 6.3%, p<0.001) at 2 years compared with patients without CI-AKI. CI-AKI was an important independent predictor of death or dialysis (HR 2.76, 95% CI 1.61 to 4.73, p<0.001) Persistent renal dysfunction after CI-AKI was documented in 68 patients (45.9%). Patients with transient renal dysfunction showed a lower 2-year event rate of death or dialysis compared with those with persistent renal dysfunction (17.9% vs 34.1%, p=0.013); however, they showed a higher event rate compared with those without CI-AKI (17.9% vs 6.3%, p<0.001).

Conclusion

Conclusion Transient and persistent renal dysfunction after CI-AKI was associated with increased short and long-term mortality and morbidity in AMI patients treated by PCI. Better preventive strategies are needed to improve clinical outcomes in AMI patients at high risk of developing CI-AKI.

  • Acute myocardial infarction
  • contrast-induced acute kidney injury
  • coronary angioplasty (PCI)
  • NSTEMI
  • renal failure
  • percutaneous coronary intervention
  • renal disease
  • STEMI

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Footnotes

  • The first two authors contributed equally to the preparation of the manuscript.

  • Funding This study was partly supported by grants from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (nos A085012 and A102064), the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (0412-CR02-0704-0001 and no A085136), and the Cardiovascular Research Center, Seoul, Republic of Korea.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Institutional Review Board of Yonsei University Health System.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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