scholarly journals The Effect of Door to Wire Crossing and the Incidence of Acute Kidney Injury in ST Segment Elevation Myocardial Infarction Patients Underwent Primary Percutaneous Coronary Intervention at H. Adam Malik Hospital Medan

2020 ◽  
Vol 6 (2) ◽  
pp. 91-96
Author(s):  
Sherly Cancerita ◽  
Harris Hasan ◽  
Zulfikri Mukhtar ◽  
Ali Nafiah Nasution ◽  
Nizam Zikri Akbar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Wire Crossing ◽  
Percutaneous Coronary

Background: ST segment elevation myocardial infarction (STEMI) causes hemodynamic changes  and an increase in endogenous vasoconstrictor release leads to renal arteriolar vasoconstriction and decreases renal perfusion and may causes acute kidney injury (AKI). Door to wire crossing is a very important prognostic marker in STEMI patients. Aims: To assess the effect of door to wire crossing and the incidence of AKI in STEMI patients with onset <12 hours undergoing primary percutaneous coronary intervention (PCI) at H. Adam Malik General Hospital Medan. Methods: This study is a cohort study conducted from October 2018 to July 2019 with study subjects of STEMI patients with onset <12 hours who underwent primary PCI that met the inclusion and exclusion criteria. Creatinine levels will be checked before and 48-72 hours after the primary PCI as well as the door to wire crossing will be recorded and compared. Result: The incidence of AKI was found around 14% in the group with a door to wire crossing <140 minutes and by 39% in the group with a door to wire crossing> 140 minutes. It was found that the final urea (p = 0.03), creatinine (p = 0.01), CrCl (p = 0.004) and changes in creatinine (p = 0.008) were statistically significant, while the contrast volume was not. In addition, the door to wire cossing >140 minutes (OR: 4.6; p = 0.032), hypertension (OR: 5.96; p = 0.018) and STEMI onset >6 hours (OR: 7.3; p = 0.019) emerged as independent predictors of AKI. Conclusion: STEMI patients with onset <12 hours who underwent primary PCI with the door to wire cossing >140 minutes have 4.6 times likelihood to develop AKI rather than those with door to wire cossing <140 minutes. The incidence of AKI ranges from 14% -39%. The independent predictors of AKI besides door to wire crossing are hypertension and STEMI's onset.

scholarly journals Admission Glucose Levels and the Risk of Acute Kidney Injury in Nondiabetic ST Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

2015 ◽  
Vol 5 (3) ◽  
pp. 191-198 ◽  
Author(s):  
Yacov Shacham ◽  
Amir Gal-Oz ◽  
Eran Leshem-Rubinow ◽  
Yaron Arbel ◽  
Gad Keren ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Glucose Levels ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Admission Glucose

Background: Hyperglycemia upon admission is associated with an increased risk for acute kidney injury (AKI) in ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). However, the relation of this association to the absence of diabetes mellitus (DM) is less studied. We evaluated the effect of acute hyperglycemia levels on the risk of AKI among STEMI patients without DM who were all treated with primary PCI. Methods: We retrospectively studied 1,065 nondiabetic STEMI patients undergoing primary PCI. Patients were stratified according to admission glucose levels into normal (<140 mg/dl), mild (140-200 mg/dl), and severe (>200 mg/dl) hyperglycemia groups. Medical records were reviewed for the occurrence of AKI. Results: The mean age was 61 ± 13 years and 81% were males. Hyperglycemia upon hospital admission was present in 402 of 1,065 patients (38%). Patients with severe admission hyperglycemia had a significantly higher rate of AKI compared to patients with no or mild hyperglycemia (20 vs. 7 and 8%, respectively; p = 0.001) and had a significantly greater serum creatinine change throughout hospitalization (0.17 vs. 0.09 and 0.07 mg/dl, respectively; p = 0.04). In multivariate logistic regression, severe hyperglycemia emerged as an independent predictor of AKI (OR = 2.46, 95% CI 1.16-5.28; p = 0.018). Conclusion: Severe admission hyperglycemia is an independent risk factor for the development of AKI among nondiabetic STEMI patients undergoing primary PCI.

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