17 Nov Heart Attack Treated With PCI: Who Gets Acute Kidney Injury?
MedicalResearch.com Interview with:
Dr. Yacov Shacham MD
Department of Cardiology Tel-Aviv Sourasky Medical Center,
Affiliated to the Sackler Faculty of Medicine
Tel-Aviv University, Tel-Aviv, Israel.
Medical Research: What is the background for this study? What are the main findings?
Dr. Shacham: Acute kidney injury (AKI) is a common complication among ST elevation (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), and it is associated with poor long-term clinical outcomes. No studies have yet evaluated the association between cardiac function and the risk of AKI in this patient population. We conducted a retrospective study of consecutive STEMI patients who underwent primary PCI and had a full echocardiography study performed within 72 hours of hospital admission. We evaluated the relation between systolic and diastolic parameters and AKI. We demonstrated that the occurrence of AKI following primary PCI was associated with worse left ventricular systolic and diastolic function, however only left ventricular EF emerged as an independent predictor of AKI.
For every 1% reduction in EF, the risk of AKI increased (OR 1.1, 95% CI 0.86-0.96; p=0.001)
Medical Research: What should clinicians and patients take away from your report?
Dr. Shacham: Among the 8 risk factors of the current, most widely applied score, published by Mehran et al to estimate the risk of CIN, 3 (hypotension, congestive heart failure, and intra-aortic balloon pump) are directly related to cardiac pump function, as was also demonstrated in a previous report by our group. It seem thus, that every effort should be made in order to decrease time to reperfusion, as the early preservation of left ventricular function may also prevent AKI complicating the course of STEMI.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Shacham: Worsening of renal function among STEMI patients undergoing PCI appears to be a frequent finding, resulting in a more complicated in hospital course and worse long term outcomes. Effort should be made trying to find other predictors for this complication, which will allow the early identification of those at risk, and enable both the use of prophylactic measures and frequent monitoring of renal function in that patient population.