https://doi.org/10.1007/s00392-025-02625-4
1Bremer Institut für Herz- und Kreislaufforschung (BIHKF) Bremen, Deutschland; 2Klinikum Bremen-Mitte Klinik für Innere Medizin III Bremen, Deutschland
Introduction: Previous studies have shown that the main contributor to acute kidney injury (AKI) in patients with ST-elevation myocardial infarctions (STEMI) maybe the infarction itself or its hemodynamic sequelae and to a lesser extent, contrast media (CM) toxicity. However, in the context of STEMI complicated by cardiogenic shock (CS) data is scarce. Aim of the present study was to investigate how high amounts of CM and results of percutaneous coronary interventions (PCI) affected AKI-rates in patients admitted with STEMI complicated by CS.
Methods: All patients admitted with STEMI complicated by CS to a large German PCI center were analysed for this study. To allow adequate diagnosis of AKI, all patients with a hospital stay of <48 hours in the PCI center were excluded. AKI was defined by KDIGO criteria.
Results: Of a total of 9363 patients with STEMI, 1152 (12.3%) presented with CS with a mean age of 63.8 years, 24% were women. In 35.2% of CS-patients AKI stage 1-could be observed, in 11.7% AKI stage 3 (with or without the need of renal replacement therapy). In a univariate analysis high amounts of CM (≥200 ml) were associated with a higher rate of AKI stage 1: 45.2%, vs. 31.9%, however the impact of high CM-amounts on AKI stage 3-rates could only be detected as a trend: 14.7% vs. 10.7%, p=0.066.
A successful PCI (TIMI flow 3 post PCI) was significantly associated with lower rates of AKI stage 1: 32.3% vs. 47.3%, p<0.01 and AKI stage 3: 10.1% vs. 17.8%, p<0.01, although these patients received on average higher amounts of CM: 161.4±72 ml vs. 126.5±79 ml, p<0.01. When adjusting for confounders in a multivariate model, higher CM-amounts were not anymore associated with a higher likelihood of neither AKI stage 1 or 3, while the association between successful PCI and a decreased AKI-risk remained significant for AKI stage 1 and 3 (table).
Table: Multivariate predictors of AKI stage 1 and 3 in STEMI-patients with CS
| AKI stage 1 | AKI stage 3 | |||||
| OR | 95% CI | p | OR | 95% CI | p | |
| CM≥200 ml* | 1.31 | 0.92-1.88 | 0.13 | 1.32 | 0.8-2.18 | 0.28 |
| TIMI 3 flow post PCI * | 0.61 | 0.41-0.90 | 0.01 | 0.57 | 0.33-0.97 | 0.04 |
*Adjusted for age, gender, multivessel disease, peak CK, LVEF<40 %, in-hospital resuscitations, in-hospital bleedings
Conclusions: In patients admitted with STEMI complicated by CS, AKI could be observed in more than a third of all patients. Patients who were successfully treated with PCI showed a lower likelihood of developing AKI stage 1 or 3, despite receiving higher doses of CM, which may indicate a nephroprotective effect of a successful PCI. In contrast, higher amounts of CM were not independently associated with a higher risk of kidney injury. Further studies would be needed to corroborate this hypothesis.