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Impact of acute kidney injury on clinical outcomes after ST elevation acute myocardial infarction.

Kim MJ, Choi HS, Oh SH, Lee HC, Kim CS, Choi JS, Park JW, Bae EH, Ma SK, Kim NH, Jeong MH, Kim SW - Yonsei Med. J. (2011)

Bottom Line: The study population was classified into 5 groups: 1) patients without AKI; 2) patients with mild AKI that was resolved by discharge (creatinine change less than 0.5mg/dL compared with admission creatinine during hospital stay, transient mild AKI); 3) patients with mild AKI that did not resolve by discharge (persistent mild AKI); 4) patients with moderate/severe AKI that was resolved by discharge (creatinine change more than 0.5 mg/dL compared with admission creatinine, transient moderate/severe AKI); 5) patients with moderate/ severe AKI that did not resolve by discharge (persistent moderate/severe AKI).Adjusted hazard ratio for mortality was 3.139 (95% CI 0.764 to 12.897, p=0.113) in patients with transient, mild AKI, and 8.885 (95% CI 2.710 to 29.128, p<0.001) in patients with transient, moderate/severe AKI compared to patients without AKI.Persistent moderate/severe AKI was also independent predictor of 1 year mortality (hazard ratio, 5.885; 95% CI 1.079 to 32.101, p=0.041).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-dong, Dong-gu, Gwangju 501-757, Korea.

ABSTRACT

Purpose: This study aimed to compare the incidence and clinical significance of transient versus persistent acute kidney injury (AKI) on acute ST elevation myocardial infarction (STEMI).

Materials and methods: The study was a retrospective cohort of 855 patients with STEMI. AKI was defined as an increase of ≥0.3 mg/dL in creatinine level at any point during hospital stay. The study population was classified into 5 groups: 1) patients without AKI; 2) patients with mild AKI that was resolved by discharge (creatinine change less than 0.5mg/dL compared with admission creatinine during hospital stay, transient mild AKI); 3) patients with mild AKI that did not resolve by discharge (persistent mild AKI); 4) patients with moderate/severe AKI that was resolved by discharge (creatinine change more than 0.5 mg/dL compared with admission creatinine, transient moderate/severe AKI); 5) patients with moderate/ severe AKI that did not resolve by discharge (persistent moderate/severe AKI). We investigated 1-year all-cause mortality after hospital discharge for the primary outcome of the study. The relation between AKI and 1-year mortality after STEMI was analyzed.

Results: AKI occurred in 74 (8.7%) patients during hospital stay. Adjusted hazard ratio for mortality was 3.139 (95% CI 0.764 to 12.897, p=0.113) in patients with transient, mild AKI, and 8.885 (95% CI 2.710 to 29.128, p<0.001) in patients with transient, moderate/severe AKI compared to patients without AKI. Persistent moderate/severe AKI was also independent predictor of 1 year mortality (hazard ratio, 5.885; 95% CI 1.079 to 32.101, p=0.041).

Conclusion: Transient and persistent moderate/severe AKI during acute myocardial infarction is strongly related to 1-year all cause mortality after STEMI.

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Related in: MedlinePlus

Kaplan-Meier survival curves according to acute kidney injury categories. AKI, acute kidney injury.
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Figure 1: Kaplan-Meier survival curves according to acute kidney injury categories. AKI, acute kidney injury.

Mentions: The median duration of follow-up after hospital discharge was 358 days. Of the 855 patients who survived their index hospitalization, a total of 25 (2.9%) deaths occurred during the follow-up period. Fig. 1 illustrates Kaplan-Meier survival in patients with AKI groups during follow-up. The Kaplan-Meier survival curves for the AKI groups showed significant differences of 1-year mortality after hospital discharge statistically. In each of the AKI groups, persistent moderate/severe AKI group showed lower probability of event-free survival compared with the other groups. Also, during the follow-up period, probability of death increased with increasing degrees of AKI.


Impact of acute kidney injury on clinical outcomes after ST elevation acute myocardial infarction.

Kim MJ, Choi HS, Oh SH, Lee HC, Kim CS, Choi JS, Park JW, Bae EH, Ma SK, Kim NH, Jeong MH, Kim SW - Yonsei Med. J. (2011)

Kaplan-Meier survival curves according to acute kidney injury categories. AKI, acute kidney injury.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104458&req=5

Figure 1: Kaplan-Meier survival curves according to acute kidney injury categories. AKI, acute kidney injury.
Mentions: The median duration of follow-up after hospital discharge was 358 days. Of the 855 patients who survived their index hospitalization, a total of 25 (2.9%) deaths occurred during the follow-up period. Fig. 1 illustrates Kaplan-Meier survival in patients with AKI groups during follow-up. The Kaplan-Meier survival curves for the AKI groups showed significant differences of 1-year mortality after hospital discharge statistically. In each of the AKI groups, persistent moderate/severe AKI group showed lower probability of event-free survival compared with the other groups. Also, during the follow-up period, probability of death increased with increasing degrees of AKI.

Bottom Line: The study population was classified into 5 groups: 1) patients without AKI; 2) patients with mild AKI that was resolved by discharge (creatinine change less than 0.5mg/dL compared with admission creatinine during hospital stay, transient mild AKI); 3) patients with mild AKI that did not resolve by discharge (persistent mild AKI); 4) patients with moderate/severe AKI that was resolved by discharge (creatinine change more than 0.5 mg/dL compared with admission creatinine, transient moderate/severe AKI); 5) patients with moderate/ severe AKI that did not resolve by discharge (persistent moderate/severe AKI).Adjusted hazard ratio for mortality was 3.139 (95% CI 0.764 to 12.897, p=0.113) in patients with transient, mild AKI, and 8.885 (95% CI 2.710 to 29.128, p<0.001) in patients with transient, moderate/severe AKI compared to patients without AKI.Persistent moderate/severe AKI was also independent predictor of 1 year mortality (hazard ratio, 5.885; 95% CI 1.079 to 32.101, p=0.041).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-dong, Dong-gu, Gwangju 501-757, Korea.

ABSTRACT

Purpose: This study aimed to compare the incidence and clinical significance of transient versus persistent acute kidney injury (AKI) on acute ST elevation myocardial infarction (STEMI).

Materials and methods: The study was a retrospective cohort of 855 patients with STEMI. AKI was defined as an increase of ≥0.3 mg/dL in creatinine level at any point during hospital stay. The study population was classified into 5 groups: 1) patients without AKI; 2) patients with mild AKI that was resolved by discharge (creatinine change less than 0.5mg/dL compared with admission creatinine during hospital stay, transient mild AKI); 3) patients with mild AKI that did not resolve by discharge (persistent mild AKI); 4) patients with moderate/severe AKI that was resolved by discharge (creatinine change more than 0.5 mg/dL compared with admission creatinine, transient moderate/severe AKI); 5) patients with moderate/ severe AKI that did not resolve by discharge (persistent moderate/severe AKI). We investigated 1-year all-cause mortality after hospital discharge for the primary outcome of the study. The relation between AKI and 1-year mortality after STEMI was analyzed.

Results: AKI occurred in 74 (8.7%) patients during hospital stay. Adjusted hazard ratio for mortality was 3.139 (95% CI 0.764 to 12.897, p=0.113) in patients with transient, mild AKI, and 8.885 (95% CI 2.710 to 29.128, p<0.001) in patients with transient, moderate/severe AKI compared to patients without AKI. Persistent moderate/severe AKI was also independent predictor of 1 year mortality (hazard ratio, 5.885; 95% CI 1.079 to 32.101, p=0.041).

Conclusion: Transient and persistent moderate/severe AKI during acute myocardial infarction is strongly related to 1-year all cause mortality after STEMI.

Show MeSH
Related in: MedlinePlus