Transient vs In-Hospital Persistent Acute Kidney Injury in Patients With Acute Coronary Syndrome

被引：12

作者：

Landi, Antonio ^{[1
]}

Branca, Mattia ^{[2
]}

Leonardi, Sergio ^{[3
,4
]}

Frigoli, Enrico ^{[1
,2
]}

Vranckx, Pascal ^{[5
,6
]}

Tebaldi, Matteo ^{[7
]}

Varbella, Ferdinando ^{[8
,9
]}

Calabro, Paolo ^{[10
,11
]}

Esposito, Giovanni ^{[12
]}

Sardella, Gennaro ^{[13
]}

Garducci, Stefano ^{[14
]}

Ando, Giuseppe ^{[15
]}

Limbruno, Ugo ^{[16
]}

Sganzerla, Paolo ^{[17
]}

Santarelli, Andrea ^{[18
]}

Briguori, Carlo ^{[19
]}

Colangelo, Salvatore ^{[20
]}

Brugaletta, Salvatore ^{[21
]}

Adamo, Marianna ^{[22
]}

Omerovic, Elmir ^{[23
,24
]}

Heg, Dik ^{[2
]}

Windecker, Stephan ^{[25
]}

Valgimigli, Marco ^{[1
,26
]}

机构：

[1] Ente Osped Cantonale, Cardioctr Ticino Inst, Div Cardiol, Lugano, Switzerland

[2] Univ Bern, CTU Bern, Bern, Switzerland

[3] Univ Pavia, Pavia, Italy

[4] Fdn IRCCS Policlin San Matteo, Pavia, Italy

[5] Jessa Ziekenhuis, Hartctr Hasselt, Dept Cardiol & Crit Care Med, Hasselt, Belgium

[6] Univ Hasselt, Fac Med & Life Sci, Hasselt, Belgium

[7] Azienda Osped Univ Ferrara, Cardiol Unit, Cona, Italy

[8] Osped Riuniti Rivoli, Cardiol Unit, ASL Torino 3, Turin, Italy

[9] Azienda Osped Univ San Luigi Gonzaga Orbassa, Cardiol Unit, Turin, Italy

[10] St Anna & San Sebastiano Hosp, Div Cardiol, Caserta, Italy

[11] Univ Campania Luigi Vanvitelli, Dept Translat Med, Caserta, Italy

[12] Federico II Univ Naples, Dept Adv Biomed Sci, Naples, Italy

[13] Sapienza Univ Rome, Policlin Umberto 1, Dept Cardiovasc Sci, Rome, Italy

[14] ASST Brianza, Vimercate Hosp, Lombardia, Italy

[15] Univ Messina, Azienda Osped Univ Policlin Gaetano Martino, Messina, Italy

[16] Misericordia Hosp, Cardiol Dept, Grosseto, Italy

[17] Osped San Luca, IRCCS Ist Auxol Italiano, Milano, TX USA

[18] Infermi Hosp, Cardiol Unit, Rimini, Italy

[19] Mediterranea Cardioctr, Intervent Cardiol Unit, Naples, Italy

[20] San Giovanni Bosco Hosp, Cardiovasc Intervent Unit, Turin, Italy

[21] Univ Barcelona, Hosp Clin, Cardiovasc Clin Inst, Inst Invest Biomed August Pi & Sunyer, Barcelona, Spain

[22] Univ Brescia, Dept Med & Surg Specialties Radiol Sci & Publ Hlt, Cardiac Catheterizat Lab & Cardiol, ASST Spedali Civili Brescia, Brescia, Italy

[23] Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden

[24] Univ Gothenburg, Inst Med, Sahlgrenska Acad, Gothenburg, Sweden

[25] Univ Bern, Dept Cardiol, Inselspital, Bern, Switzerland

[26] Univ Italian Switzerland, Dept Biomed Sci, Lugano, Switzerland

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2023年 / 16卷 / 02期

关键词：

acute coronary syndrome; percutaneous coronary intervention; persistent acute kidney injury; transient acute kidney injury; RENAL DYSFUNCTION; INTERVENTION; ACCESS; RISK;

D O I：

10.1016/j.jcin.2022.10.009

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The occurrence of acute kidney injury (AKI) among patients with acute coronary syndrome (ACS) undergoing invasive management is associated with worse outcomes. However, the prognostic implications of transient or in-hospital persistent AKI may differ.OBJECTIVES The aim of this study was to evaluate the prognostic implications of transient or in-hospital persistent AKI in patients with ACS.METHODS In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial, 203 subjects were excluded because of incomplete information or end-stage renal disease, with a study population of 8,201 patients. Transient and persistent AKI were defined as renal dysfunction no longer or still fulfilling the AKI criteria (>0.5 mg/dL or a relative >25% increase in creatinine) at discharge, respectively. Thirty-day coprimary outcomes were the out-of-hospital composite of death, myocardial infarction, or stroke (major adverse cardiovascular events [MACE]) and net adverse cardiovascular events (NACE), defined as the composite of MACE or Bleeding Academic Research Consortium type 3 or 5 bleeding.RESULTS Persistent and transient AKI occurred in 750 (9.1%) and 587 (7.2%) subjects, respectively. After multivariable adjustment, compared with patients without AKI, the risk for 30-day coprimary outcomes was higher in patients with persistent AKI (MACE: adjusted HR: 2.32; 95% CI: 1.48-3.64; P < 0.001; NACE: adjusted HR: 2.29; 95% CI: 1.48-3.52; P < 0.001), driven mainly by all-cause mortality (adjusted HR: 3.43; 95% CI: 2.03-5.82; P < 0.001), whereas transient AKI was not associated with higher rates of MACE or NACE. Results remained consistent when implementing the KDIGO (Kidney Disease Improving Global Outcomes) criteria.CONCLUSIONS Among patients with ACS undergoing invasive management, in-hospital persistent but not transient AKI was associated with higher risk for 30-day MACE and NACE. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox [MATRIX]; NCT01433627) (J Am Coll Cardiol Intv 2023;16:193-205)& COPY; 2023 by the American College of Cardiology Foundation.

引用

页码：193 / 205

页数：13

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