Acute kidney injury risk in patients with ST-segment elevation myocardial infarction at presentation to the ED

• Published in: The American journal of emergency medicine 2012-11, Vol.30 (9), p.1921-1927
• Main Authors: Queiroz, Rafaela Elizabeth Bayas, de Oliveira, Leilane Siqueira Nobre, de Albuquerque, Cláudio Alves, Santana, Caroline de Alencar, Brasil, Patrícia Maia, Carneiro, Luzia Layla Rodrigues, Libório, Alexandre Braga
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - etiology; Adrenergic beta-Antagonists - adverse effects; Age Factors; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Coronary Angiography; Coronary heart disease; Electrocardiography; Emergency; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Enzyme inhibitors; Female; Glomerular Filtration Rate; Health risks; Heart; Heart attacks; Heart Rate; Hospitalization; Humans; Intensive care medicine; Kidney diseases; Kidneys; Male; Medical sciences; Middle Aged; Mortality; Multivariate analysis; Myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - physiopathology; Retrospective Studies; Risk Factors
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2012.04.011

Abstract Introduction Acute kidney injury (AKI) is common in acute myocardial infarction (AMI) patients and has serious prognostic implications. The early identification of patients at risk of developing AKI at the emergency department (ED) can reduce its incidence. Methods Patients with ST-segment elevation myocardial infarction (STEMI) at the ED were included. Associated factors playing a role at ED presentation and during hospitalization were collected, and independent risk factors of developing AKI were assessed. Results Mean age among patients (n = 406, 69.7% male) was 62.5 ± 12.5 years. At ED admission, the mean glomerular filtration rate (GFR) was 70.5 ± 28.1 mL/min per 1.73 m2 , and 140 (34.5%) patients had a GFR < 60 mL/min per 1.73 m2 . Eighty-three patients (20.4%) developed AKI: 47 (11.6%) with stage 1, 26 (6.4%) with stage 2 and 10 (2.5%) with stage 3. Mortality was 11.8% and was higher in patients with AKI (34.9% vs 5.9%, P < .0001). Univariate analysis disclosed age, reduced GFR at presentation, severe Killip class, heart rate and longer door-to-needle time as risk factors to develop AKI. Moreover, these patients received less β -blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker in the ED. Multivariate analysis revealed that age, Killip class, heart rate, door-to-needle time, and β -blocker non-use were independent factors associated with AKI. These factors provided the ED physician with good accuracy in identifying patients at high risk of developing AKI. Conclusion Factors associated with AKI in STEMI patients allowed physicians to identify patients at high risk in the ED. Moreover, reduced door-to-needle time and β -blocker use were associated with renal protection in AMI patients.