Risk Factors And Prognosis Of Acute Kidney Injury After PPCI In Patients With Acute ST-segment Elevation Myocardial Infarction

Objectives: To investigate the risk factors of acute kidney injury(AKI)after primary percutaneous coronary intervention(PPCI)in patients with ST-segment elevation myocardial infarction(STEMI),and to observe the effect of AKI on short-term during hospitalization and long-term outcomes.Methods: A total of 483 STEMI patients in Hebei general hospital were enrolled from December 2016 to August 2018,including 370 patients who underwent PPCI and 113 patients who were not exposed to contrast material.AKI was defined as serum creatinine rise?26.5?mol/L within 48 h,or an increase in serum creatinine to 1.5 times baseline or more which is known or presumed to have occurred within the prior 7 days.They were divided into AKI group and non-AKI group according to the occurrence of acute kidney injury in the observation time window.The baseline data,angiographic and interventional data,nosocomial complications(including heart failure,infections,hemorrhage,death)and major adverse cardiovascular events(MACE)(including cardiac death,nonfatal myocardial infarction,unstable angina or heart failure readmission)during follow-up after discharge were compared between the two groups.Affecting factors of AKI were analyzed by multivariable logistic regression.Impact factors of MACE were analyzed by Cox regression analysis.No contrast material exposure group was defined as the patients who received conservative treatment and not contact with contrast material.Selecting 12 match variables,propensity score matching method was used to match PPCI group and no contrast material exposure group by 1:1.The matching standard(caliper)was set to 0.01.Propensity score matching resulted in 86 matched pairs.The incidence of AKI was compared in the two group matches in order to obtain the effect of contrast material on AKI.Results: The incidence of AKI in STEMI patients undergoing PPCI was 11.4%.Compared with the non-AKI group,the incidence of nosocomial complications(nosocomial heart failure,infection,bleeding,and death)was significantly higher in the AKI group(P<0.001),and the nosocomial mortality in the AKI group was up to 28.6%(28.6% VS 0.3%,P=0.001).Multivariate logistic regression analysis revealed that age,hypertension,Left ventricular ejection fraction(LVEF)<50%,intra-aortic balloon pumping(IABP),increased white blood cell count,and decreased hemoglobin were independent predictors for AKI.Patients with AKI had higher MACE incidence(48.1% VS 21.1%,P=0.001)in the follow-up.COX regression showed that AKI was an independent influencing factor for MACE in STEMI patients(HR2.381,95%CI1.208-4.697,P=0.012).After propensity score matching,baseline characteristics were balanced between the PPCI group and the no contrast material exposure group,and the difference was not statistically significant(P>0.05).The two groups could be comparable,and the incidence of AKI in the PPCI group was higher than that group without contrast material exposure(22.1% VS 9.3%,P=0.021)after matched.Conclusion: AKI is very common in STEMI patients after primary percutaneous coronary intervention and it can seriously affect the mortality in hospital and long-term prognosis of patients.By comparing the PPCI group with the group without contrast material exposure in STEMI patients,we obtained that contrast material is a risk factor for AKI,other risk factors include age,history of hypertension,LVEF <50%,IABP use,increased white blood cell count,and decreased hemoglobin.