Dynamics of Renal Functional Status and Predictors of Acute Kidney Injury Development in Stemi Patients After Revascularization
Year: 2024
Type: article
Study design: Observational Study
Abstract: The aim of the study is to assess the functional status of the kidneys in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent urgent revascularization within 3 days, and to identify independent predictors of acute kidney injury.Material and methods. A prospective, single-center study involving 286 STEMI patients with a mean age of 62.8±9.8 years, who were hospitalized within 12 hours of pain onset to Vinnytsia Regional Center for Cardiovascular Pathology. Among the examined patients, there were 202 men (70.6%) and 84 women (29.4%). Results. A decrease in creatinine levels of more than 10% from baseline on the 3rd day of observation was recorded in 93 patients (36.0%), who were distributed into Group I for further analysis. Group II consisted of 165 patients (64%) without negative creatinine dynamics. In Group I, there were significantly more men, 77.4% compared to 66.1%, p=0.06, which generally contradicts the existing data on the influence of female gender on renal functional status. Patients in Group I were younger than those in Group II; there were significantly more individuals with a BMI of 20-25 kg/m² in Group II (p=0.05). Among individuals in Group I, there was a statistically significant difference in the prevalence of type 2 diabetes, with 27 (29.0%) compared to 26 (15.8%), p=0.01, and atrial fibrillation (all forms), with 16 (17.2%) compared to 13 (7.9%), p=0.02.It was found that the level of troponin I was significantly higher in Group I, p=0.01. Additionally, interesting data were observed regarding the frequency of diagnosed cases of acute heart failure – Killip III and Killip IV – among patients in Group I, which were statistically significant compared to patients in Group II, p=0.002 and p=0.008, respectively. Highly informative (p<0.00001) independent predictors of acute kidney injury development in patients with ACS after PCI should include the glomerular filtration rate (GFR) calculated by CKD-EPI Cystatin C on the 1st day, the left atrial size in mm according to echocardiography data, and the hemoglobin level in g/L on day 1 (F=42.43, 34.20, and 32.39, respectively, compared to 32.31 for the model).Conclusions. Thus, a decrease in creatinine levels of more than 10% from baseline on the 3rd day of observation was recorded in 93 patients (36.0%). A decrease in creatinine levels was more frequently observed among younger men with normal baseline renal function. The decrease in creatinine levels was associated with acute heart failure Killip III-IV, atrial fibrillation, and type 2 diabetes.
Source: Bukovinian Medical Herald
Author: A.V. Broniuk
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4408344779