https://doi.org/10.1007/s00392-025-02625-4
1Friedrich-Alexander Universität Erlangen-Nürnberg Medizinische Klinik 2 Erlangen, Deutschland
BACKGROUND:
Acute kidney injury (AKI) is a common and serious complication in patients with ST-elevation myocardial infarction (STEMI), associated with worse prognosis and increased mortality. While most research has focused on STEMI patients in cardiogenic shock, little is known about the incidence and risk factors for AKI in STEMI patients who do not present with cardiogenic shock. Identifying clinical, laboratory and procedural risk parameters for AKI in this subgroup is crucial, since early detection and management of AKI could potentially improve patient outcomes. This study therefore aims to identify clinical, laboratory and procedural predictors associated with AKI in STEMI patients without cardiogenic shock.
METHODS:
In this retrospective analysis, all patients diagnosed with ST-elevation myocardial infarction (STEMI), who underwent invasive coronary angiography at our department between 2015 and 2023 (n=1245) were included. The presence of cardiogenic shock was an exclusion criterion, defined as the presentation with a systolic blood pressure below 90mmHg for over five minutes, the need for left ventricular assist-device support, catecholamine therapy or mechanical ventilation. We defined AKI according to the AKIN criteria with an increase of ≥0.3mg/dl creatinine or an increase of ≥1.5 fold within 72 hours after invasive management. Patients were additionally categorized into AKIN stage 1 (≥0.3mg/dl increase/1.5-1.9-fold increase), stage 2 (2.0-2.9-fold increase) or stage 3 (≥3-fold increase, creatinine ≥4mg/dl or acute increase of ≥0.5mg/dl). Clinical, laboratory and procedural parameters of patients with acute kidney injury (AKI) were compared to those without AKI. Multiple regression analysis was performed to identify independent predictors for the development of AKI.
RESULTS:
Of the 1245 STEMI patients, 910 (73%) presented without cardiogenic shock (74% male, mean age 69±14 years): Overall, AKI occurred in 54 patients (6%). Out of those, stage 1 AKI was observed in 90%, Stage 2 in 4% and stage 3 in 6% of cases. Independent predictors for AKI were lower systolic left ventricular ejection fraction (LVEF; p<0.001; OR 0.95 (0.92-0.97) per 1% LVEF, higher age (p<0.001; OR 1.05 (1.02-1.07) per year, known atrial fibrillation (p=0.035; OR 2.60 (1.07-6.30) and pre-existing renal insufficiency (p<0.001, OR 8.41 (4.50-15.73). Baseline characteristics such as gender, BMI, prior coronary artery bypass graft, as well as time delays until reperfusion or procedural characteristics such as access route or culprit lesion did not differ between the groups. In particular, the amount of contrast medium showed no influence on the occurence of AKI (p=0.51).
CONCLUSION:
In STEMI patients without cardiogenic shock, reduced LVEF, higher age, known atrial fibrillation and pre-existing renal insufficiency were associated with a higher risk of AKI. These parameters may help identify patients at a greater risk, supporting targeted monitoring and early intervention.