The impact of transient and persistent acute kidney injury on long-term outcomes after acute myocardial infarction

Abstract BackgroundThe prognostic role of hyperglycemia in patients with myocardial infarction and obstructive coronary arteries (MIOCA) is acknowledged, while data on non-obstructive coronary arteries (MINOCA) are still lacking. Recently, we demonstrated that admission stress-hyperglycemia (aHGL) was associated with a larger infarct size and inflammatory response in MIOCA, while no differences were observed in MINOCA. We aim to investigate the impact of aHGL on short and long-term outcomes in MIOCA and MINOCA patients.MethodsMulticenter, population-based, cohort study of the prospective registry, designed to evaluate the prognostic information of patients admitted with acute myocardial infarction to S. Orsola-Malpighi and Maggiore Hospitals of Bologna metropolitan area. Among 2704 patients enrolled from 2016 to 2020, 2431 patients were classified according to the presence of aHGL (defined as admission glucose level ≥ 140mg/dL) and AMI phenotype (MIOCA/MINOCA): no-aHGL (n = 1321), aHGL (n = 877) in MIOCA and no-aHGL (n = 195), aHGL (n = 38) in MINOCA. Short-term outcomes included in-hospital death and arrhythmias. Long-term outcomes were all-cause and cardiovascular mortality.ResultsaHGL was associated with a higher in-hospital arrhythmic burden in MINOCA and MIOCA, with increased in-hospital mortality only in MIOCA. After adjusting for age, gender, hypertension, Killip class and AMI phenotypes, aHGL predicted higher in-hospital mortality in non-diabetic (HR = 4.2; 95% CI 1.9–9.5, p = 0.001) and diabetic patients (HR = 3.5, 95% CI 1.5–8.2, p = 0.003). During long-term follow-up, aHGL was associated with 2-fold increased mortality in MIOCA and a 4-fold increase in MINOCA (p = 0.032 and p = 0.016). Kaplan Meier 3-year survival of non-hyperglycemic patients was greater than in aHGL patients for both groups. No differences in survival were found between hyperglycemic MIOCA and MINOCA patients. After adjusting for age, gender, hypertension, smoking, LVEF, STEMI/NSTEMI and AMI phenotypes (MIOCA/MINOCA), aHGL predicted higher long-term mortality.ConclusionsaHGL was identified as a strong predictor of adverse short- and long-term outcomes in both MIOCA and MINOCA, regardless of diabetes. aHGL should be considered a high-risk prognostic marker in all AMI patients, independently of the underlying coronary anatomy.Trial Registrationdata were part of the ongoing observational study AMIPE: Acute Myocardial Infarction, Prognostic and Therapeutic Evaluation. ClinicalTrials.gov Identifier: NCT03883711.

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TCT-424: The Impact of Contrast-Induced Nephropathy on Long-term Outcomes in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Interventions

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2010.08.495 ◽

2010 ◽

Vol 56 (13) ◽

pp. B97

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Interventions ◽

Long Term Outcomes ◽

Contrast Induced Nephropathy ◽

Coronary Interventions ◽

Percutaneous Coronary ◽

The Impact

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Impact of high bleeding risk criteria on short- and long-term outcomes in patients with acute myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1641 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Dai ◽

A.O Okada ◽

Y.H Hyodo ◽

T.N Nakano ◽

S.T Tomomori ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Bleeding Risk ◽

Long Term Outcomes ◽

Kaplan Meier ◽

Short And Long Term ◽

High Bleeding Risk ◽

Minor Criteria ◽

The Impact

Abstract Background The Academic Research Consortium (ARC) proposed the new definition of high bleeding risk (HBR) criteria. It remains unknown about the prevalence and the impact of HBR on clinical outcome after acute myocardial infarction (AMI). Purpose To assess the prevalence and the impact of HBR on short- and long-term outcomes in patients with AMI. Methods Between January 2015 and January 2018, 412 patients with AMI underwent coronary angiography within 24 hours after the onset of chest pain. According to HBR criteria proposed by ARC, we divided patients into 2 groups; HBR and non-HBR group. We considered a patient HBR if the patient met at least 1 major criteria or 2 minor criteria. Major criteria included severe CKD (eGFR<30 ml/min), severe anemia (Hgb<11 g/dl), active cancer, and the use of oral anticoagulant drug. Minor criteria included high age (≥75), moderate CKD (eGFR 30–59 ml/min), moderate anemia (Hgb 11–12.9 g/dl for men and 11–11.9 g/dl for women). Kaplan-meier method was used to compare long-term outcome of HBR and non-HBR group. Major adverse cardiovascular events (MACE) were defined as all-cause death, non-fetal MI, and stroke. Results Patients with HBR were found in 37% of patients with AMI. In-hospital mortality (11.3% vs 4.2%, p=0.008) and MACE rate was significantly higher in HBR than non-HBR group (Figure). HBR group was associated with higher all-cause death (15.7% vs 2.5%, p<0.0001) and intracranial bleeding (4.8% vs 0.5%, p=0.02) than non-HBR group, although the incidence of non-fetal MI was comparable between two groups (7.6% vs 8.5%, p=0.76). Conclusions AMI patients with HBR were associated with worse outcomes both short- and long-term. Kaplan-Meier curves for MACE Funding Acknowledgement Type of funding source: None

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Long-term Prognosis of Acute Kidney Injury After Acute Myocardial Infarction

Archives of Internal Medicine ◽

10.1001/archinte.168.9.987 ◽

2008 ◽

Vol 168 (9) ◽

pp. 987 ◽

Cited By ~ 193

Author(s):

Chirag R. Parikh ◽

Steven G. Coca ◽

Yongfei Wang ◽

Frederick A. Masoudi ◽

Harlan M. Krumholz

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Long Term Prognosis

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Impact of acute kidney injury on anticancer treatment dosage and long-term outcomes: a pooled analysis of European Organisation for Research and Treatment of Cancer trials

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa049 ◽

2020 ◽

Cited By ~ 1

Author(s):

Julien Péron ◽

Anouk Neven ◽

Laurence Collette ◽

Vincent Launay-Vacher ◽

Ben Sprangers ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Function ◽

Advanced Cancer ◽

Kidney Injury ◽

Dose Intensity ◽

Long Term Outcomes ◽

European Organisation ◽

Treatment Dose ◽

The Impact

Abstract Background The impact of kidney dysfunction on long-term outcomes of patients with advanced cancer remains unclear. Methods Patients with advanced cancer included in trials conducted by the European Organisation for Research and Treatment of Cancer were eligible for this retrospective analysis. Acute kidney injury (AKI) was identified using serum creatinine levels and using adverse events reported by investigators. The impact of baseline estimated glomerular filtration rates (eGFRs) on progression-free survival (PFS) and overall survival (OS) was investigated. Pooled estimates of the impact of AKI on dose intensity, treatment duration, PFS and OS were obtained following a meta-analytic process. Results Nine trials were included in this study, totalling 2872 metastatic patients with various tumour types and various systemic treatment types. Baseline eGFR had homogeneously no impact on PFS or OS. Most Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE) events occurred early during the course of the treatment. AKI was not associated with an increased rate of treatment discontinuation, while it decreased the study treatment dose intensity. Occurrence of a first RIFLE event significantly and homogeneously reduced PFS (pooled hazard ratio = 1.18, 95% confidence interval 1.07–1.30; P = 0.0012), while its impact on OS was more heterogeneous across trials. Conclusion AKI is associated with reduced treatment dose intensity and reduced PFS. Therefore, close monitoring of the kidney function during the first months of treatment should be included in clinical trial protocols and probably also in daily practice to enable early AKI diagnosis and management. Collaboration between oncologists and nephrologists is needed to reduce the risk of undertreatment of patients experiencing AKI.

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