Persistent Renal Dysfunction in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction
Background The long‐term prognosis of patients with acute myocardial infarction who develop persistent renal dysfunction (RD) remains unclear. We investigated risk factors and prognostic implications of persistent RD after contrast‐induced nephropathy (CIN) in patients with acute myocardial infarcti...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.014096 |
| _version_ | 1818775851844501504 |
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| author | Kazumasa Kurogi Masanobu Ishii Kenji Sakamoto Soichi Komaki Kyohei Marume Hiroaki Kusaka Nobuyasu Yamamoto Yuichiro Arima Eiichiro Yamamoto Koichi Kaikita Kenichi Tsujita |
| author_facet | Kazumasa Kurogi Masanobu Ishii Kenji Sakamoto Soichi Komaki Kyohei Marume Hiroaki Kusaka Nobuyasu Yamamoto Yuichiro Arima Eiichiro Yamamoto Koichi Kaikita Kenichi Tsujita |
| author_sort | Kazumasa Kurogi |
| collection | DOAJ |
| description | Background The long‐term prognosis of patients with acute myocardial infarction who develop persistent renal dysfunction (RD) remains unclear. We investigated risk factors and prognostic implications of persistent RD after contrast‐induced nephropathy (CIN) in patients with acute myocardial infarction after primary percutaneous coronary intervention. Methods and Results We enrolled 952 consecutive patients who underwent primary percutaneous coronary intervention for acute myocardial infarction. CIN was defined as an increase in serum creatinine levels ≥0.5 mg/dL or ≥25% from baseline within 72 hours after percutaneous coronary intervention. Persistent RD was defined as residual impairment of renal function over 2 weeks, and transient RD was defined as recovery of renal function within 2 weeks, after CIN. The overall incidence of CIN was 8.8% and that of persistent CIN was 3.1%. A receiver‐operator characteristic curve showed that the optimal cutoff value of the contrast volume/baseline estimated glomerular filtration rate ratio for persistent CIN was 3.45. In multivariable logistic analysis, a contrast volume/baseline estimated glomerular filtration rate >3.45 was an independent correlate of persistent RD. At 3 years, the incidence of death was significantly higher in patients with persistent RD than in those with transient RD (P=0.001) and in those without CIN (P<0.001). Cox regression analysis showed that persistent RD (hazard ratio, 4.99; 95% CI, 2.30–10.8; P<0.001) was a significant risk factor for mortality. A similar trend was observed for the combined end points, which included mortality, hemodialysis, stroke, and acute myocardial infarction. Conclusions Persistent RD, but not transient RD, is independently associated with long‐term mortality. A contrast volume/baseline estimated glomerular filtration rate >3.45 is an independent predictor of persistent RD. |
| first_indexed | 2024-12-18T11:03:37Z |
| format | Article |
| id | doaj.art-4bc3d8575aae4846b5552b9a3b147372 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-18T11:03:37Z |
| publishDate | 2019-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-4bc3d8575aae4846b5552b9a3b1473722022-12-21T21:10:10ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-12-0182310.1161/JAHA.119.014096Persistent Renal Dysfunction in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial InfarctionKazumasa Kurogi0Masanobu Ishii1Kenji Sakamoto2Soichi Komaki3Kyohei Marume4Hiroaki Kusaka5Nobuyasu Yamamoto6Yuichiro Arima7Eiichiro Yamamoto8Koichi Kaikita9Kenichi Tsujita10Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki JapanDepartment of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki JapanDepartment of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto JapanDepartment of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki JapanDepartment of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki JapanDepartment of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki JapanDepartment of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki JapanDepartment of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto JapanDepartment of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto JapanDepartment of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto JapanDepartment of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto JapanBackground The long‐term prognosis of patients with acute myocardial infarction who develop persistent renal dysfunction (RD) remains unclear. We investigated risk factors and prognostic implications of persistent RD after contrast‐induced nephropathy (CIN) in patients with acute myocardial infarction after primary percutaneous coronary intervention. Methods and Results We enrolled 952 consecutive patients who underwent primary percutaneous coronary intervention for acute myocardial infarction. CIN was defined as an increase in serum creatinine levels ≥0.5 mg/dL or ≥25% from baseline within 72 hours after percutaneous coronary intervention. Persistent RD was defined as residual impairment of renal function over 2 weeks, and transient RD was defined as recovery of renal function within 2 weeks, after CIN. The overall incidence of CIN was 8.8% and that of persistent CIN was 3.1%. A receiver‐operator characteristic curve showed that the optimal cutoff value of the contrast volume/baseline estimated glomerular filtration rate ratio for persistent CIN was 3.45. In multivariable logistic analysis, a contrast volume/baseline estimated glomerular filtration rate >3.45 was an independent correlate of persistent RD. At 3 years, the incidence of death was significantly higher in patients with persistent RD than in those with transient RD (P=0.001) and in those without CIN (P<0.001). Cox regression analysis showed that persistent RD (hazard ratio, 4.99; 95% CI, 2.30–10.8; P<0.001) was a significant risk factor for mortality. A similar trend was observed for the combined end points, which included mortality, hemodialysis, stroke, and acute myocardial infarction. Conclusions Persistent RD, but not transient RD, is independently associated with long‐term mortality. A contrast volume/baseline estimated glomerular filtration rate >3.45 is an independent predictor of persistent RD.https://www.ahajournals.org/doi/10.1161/JAHA.119.014096acute myocardial infarctioncontrast‐induced nephropathypercutaneous coronary intervention |
| spellingShingle | Kazumasa Kurogi Masanobu Ishii Kenji Sakamoto Soichi Komaki Kyohei Marume Hiroaki Kusaka Nobuyasu Yamamoto Yuichiro Arima Eiichiro Yamamoto Koichi Kaikita Kenichi Tsujita Persistent Renal Dysfunction in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute myocardial infarction contrast‐induced nephropathy percutaneous coronary intervention |
| title | Persistent Renal Dysfunction in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction |
| title_full | Persistent Renal Dysfunction in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction |
| title_fullStr | Persistent Renal Dysfunction in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction |
| title_full_unstemmed | Persistent Renal Dysfunction in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction |
| title_short | Persistent Renal Dysfunction in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction |
| title_sort | persistent renal dysfunction in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction |
| topic | acute myocardial infarction contrast‐induced nephropathy percutaneous coronary intervention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.014096 |
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