scholarly journals Prolonged Hyperglycemia and Renal Failure after Primary Percutaneous Coronary Intervention

2019 ◽  
Vol 9 (2) ◽  
pp. 92-99
Author(s):  
Elena Izkhakov ◽  
Zach Rozenbaum ◽  
Gilad Margolis ◽  
Shafik Khoury ◽  
Gad Keren ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Kidney Injury ◽  
Fold Increase ◽  
Coronary Intervention ◽  
Primary Pci ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Hba1c Levels

Background: There are limited data regarding the effect of long-standing hyperglycemia on the occurrence of acute kidney injury (AKI) in ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Methods: We retrospectively studied 723 STEMI patients undergoing primary PCI. Patients were stratified into two groups according to glycated hemoglobin (HbA1c) levels as a marker of prolonged hyperglycemia: those with HbA1c < 7% and those with HbA1c ≥7%. Medical records were reviewed for the occurrence of AKI. Results: HbA1c levels ≥7% were found in 225/723 (31%) of patients. The occurrence of AKI was significantly higher among patients with HbA1c levels ≥7% (32/225, 14%) compared to patients with HbA1c levels < 7% (32/498, 6%; p = 0.001). Patients with chronic kidney disease (CKD) and HbA1c ≥7% had an eight-fold increase in the incidence of AKI compared to patients with HbA1c < 7% and no CKD (32 vs. 4%). In a multivariable regression model, HbA1c ≥7% was independently associated with AKI (OR 1.92, 95% CI 1.09–3.36, p = 0.02). Conclusion: HbA1c ≥7% was associated with a higher likelihood of AKI in STEMI patients treated with primary PCI.

scholarly journals Clinical Scoring for Prediction of Acute Kidney Injury in Patients with Acute ST-Segment Elevation Myocardial Infarction after Emergency Primary Percutaneous Coronary Intervention

2021 ◽  
Vol 10 (15) ◽  
pp. 3402
Author(s):  
Akaphol Kaladee ◽  
Phichayut Phinyo ◽  
Thamarath Chantadansuwan ◽  
Jayanton Patumanond ◽  
Boonying Siribumrungwong
Keyword(s):  
Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Acute kidney injury (AKI) after a coronary intervention is common in patients with ST-segment elevation myocardial infarction (STEMI) and is associated with significant morbidity and mortality. Several scores have been developed to predict post-procedural AKI over the years. However, the AKI definitions have also evolved, which causes the definitions used in the past to be obsolete. We aimed to develop a prediction score for AKI in patients with STEMI requiring emergency primary percutaneous coronary intervention (pPCI). This study was based on a retrospective cohort of Thai patients with STEMI who underwent pPCI at the Central Chest Institute of Thailand from December 2014 to September 2019. AKI was defined as an increase in serum creatinine of at least 0.3 mg/dL from baseline within 48 h after pPCI. Logistic regression was used for modeling. A total of 1617 patients were included. Of these, 195 patients had AKI (12.1%). Eight significant predictors were identified: age, baseline creatinine, left ventricular ejection fraction (LVEF) < 40%, multi-vessel pPCI, treated with thrombus aspiration, inserted intra-aortic balloon pump (IABP), pre- and intra-procedural cardiogenic shock, and congestive heart failure. The score showed an area under the receiver operating characteristic curve of 0.78 (95% CI 0.75, 0.82) and was well-calibrated. The pPCI-AKI score showed an acceptable predictive performance and was potentially useful to help interventionists stratify the patients and provide optimal preventive management.

Abstract 6275: Increased Mortality after Primary Percutaneous Coronary Intervention for Acute ST Segment Elevation Myocardial Infarction During Off-Hours

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Roberto J Cubeddu ◽  
Ignacio Cruz-Gonzalez ◽  
Thomas J Kiernan ◽  
Robert C Leinbach ◽  
Quynh A Truong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary

Background: Higher mortality has been reported in patients admitted with acute myocardial infarction during off-hours, and has been related to a lower use of primary percutaneous coronary intervention (PCI). Methods: We thus conducted a study, where primary PCI is routinely performed in all patients with ST elevation myocardial infarction (STEMI) regardless of the day and time of admission. Patients admitted during on-hours (Monday through Friday 7am–6pm) where compared to off-hours (including weekends). The outcome of in-hospital mortality, cardiogenic shock and recurrent myocardial infarction was explored. The different components of door-to-balloon (DTB) time were examined and compared between both groups. Results: Between 2003 and 2007, 747 STEMI patients (46% on-hours vs. 56% off-hours) underwent primary PCI. Patient baseline demographic characteristics were similar during on-vs. off-hours. Admissions during off-hours were associated with longer DTB times (134 vs. 109 minutes, p<0.0001). Furthermore, patients admitted during off-hours had significantly greater in-hospital mortality (8% vs. 3.7%, p=0.01), and higher rates of cardiogenic shock (37% vs. 24%, p=0.0001). Multivariate analysis identified admission arrival time as an independent predictor of in-hospital mortality (HR 3.98; 95% CI 1.10 –14.38; p=0.035). Longer DTB times were attributed to the increased “engagement time” during off-hours (27 vs. 47 minutes, p<0.00001). Conclusion: 1) This study is the first to show that even when treated equally with primary PCI, off-hours STEMI admissions have higher mortality than on-hours. Longer DTB time during off-hours likely explain our findings. Strategies to optimize hospital protocols, reperfusion therapies, and perhaps a dedicated in-house “STEMI team” during off-hours need to be revised.

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