Acute kidney injury risk in patients with ST-segment elevation myocardial infarction at presentation to the ED
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Fig. 1
Acute kidney injury stages according to GFR at the time of ED admission.
Fig. 2
Incidence of AKI according to heart rate at the time of ED admission.
Fig. 3
AKI score calibration.
Fig. 4
Discrimination of risk scores for the development of AKI after STEMI. “Score at the ED” includes age, Killip class, heart rate at admission, door-to-needle time, and β-blocker use. The weight of each variable was based on multivariate analysis coefficients.
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.
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