Transient vs In-Hospital Persistent Acute Kidney Injury in Patients With Acute Coronary Syndrome

Antonio Landi; Mattia Branca; Sergio Leonardi; Enrico Frigoli; Pascal Vranckx; Matteo Tebaldi; Ferdinando Varbella; Paolo Calabró; Giovanni Esposito; Gennaro Sardella; Stefano Garducci; Giuseppe Andò; Ugo Limbruno; Paolo Sganzerla; Andrea Santarelli; Carlo Briguori; Salvatore Colangelo; Salvatore Brugaletta; Marianna Adamo; Elmir Omerovic; Dik Heg; Stephan Windecker; Marco Valgimigli; MATRIX Investigators

doi:10.1016/j.jcin.2022.10.009

Transient vs In-Hospital Persistent Acute Kidney Injury in Patients With Acute Coronary Syndrome

JACC Cardiovasc Interv. 2023 Jan 23;16(2):193-205. doi: 10.1016/j.jcin.2022.10.009. Epub 2022 Dec 28.

Authors

Antonio Landi¹, Mattia Branca², Sergio Leonardi³, Enrico Frigoli⁴, Pascal Vranckx⁵, Matteo Tebaldi⁶, Ferdinando Varbella⁷, Paolo Calabró⁸, Giovanni Esposito⁹, Gennaro Sardella¹⁰, Stefano Garducci¹¹, Giuseppe Andò¹², Ugo Limbruno¹³, Paolo Sganzerla¹⁴, Andrea Santarelli¹⁵, Carlo Briguori¹⁶, Salvatore Colangelo¹⁷, Salvatore Brugaletta¹⁸, Marianna Adamo¹⁹, Elmir Omerovic²⁰, Dik Heg², Stephan Windecker²¹, Marco Valgimigli²²; MATRIX Investigators

Affiliations

¹ Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
² CTU Bern, University of Bern, Switzerland.
³ University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
⁴ Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; CTU Bern, University of Bern, Switzerland.
⁵ Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium.
⁶ Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy.
⁷ Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3, Turin, Italy; Cardiology Unit, Azienda Ospedaliera Universitaria San Luigi Gonzaga Orbassano, Turin, Italy.
⁸ Division of Cardiology, "Sant'Anna e San Sebastiano" Hospital, Caserta, Italy; Department of Translational Medicine, University of Campania "Luigi Vanvitelli," Caserta, Italy.
⁹ Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
¹⁰ Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
¹¹ Vimercate Hospital, ASST della Brianza, Italy.
¹² Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino," University of Messina, Messina, Italy.
¹³ Cardiology Department, Misericordia Hospital, Grosseto, Italy.
¹⁴ IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milano.
¹⁵ Cardiology Unit, Infermi Hospital, Rimini, Italy.
¹⁶ Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy.
¹⁷ Cardiovascular Intervention Unit, San Giovanni Bosco Hospital, Turin, Italy.
¹⁸ Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
¹⁹ Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
²⁰ Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²¹ Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
²² Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland. Electronic address: marco.valgimigli@eoc.ch.

PMID: 36697156
DOI: 10.1016/j.jcin.2022.10.009

Abstract

Background: The occurrence of acute kidney injury (AKI) among patients with acute coronary syndrome (ACS) undergoing invasive management is associated with worse outcomes. However, the prognostic implications of transient or in-hospital persistent AKI may differ.

Objectives: The aim of this study was to evaluate the prognostic implications of transient or in-hospital persistent AKI in patients with ACS.

Methods: In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial, 203 subjects were excluded because of incomplete information or end-stage renal disease, with a study population of 8,201 patients. Transient and persistent AKI were defined as renal dysfunction no longer or still fulfilling the AKI criteria (>0.5 mg/dL or a relative >25% increase in creatinine) at discharge, respectively. Thirty-day coprimary outcomes were the out-of-hospital composite of death, myocardial infarction, or stroke (major adverse cardiovascular events [MACE]) and net adverse cardiovascular events (NACE), defined as the composite of MACE or Bleeding Academic Research Consortium type 3 or 5 bleeding.

Results: Persistent and transient AKI occurred in 750 (9.1%) and 587 (7.2%) subjects, respectively. After multivariable adjustment, compared with patients without AKI, the risk for 30-day coprimary outcomes was higher in patients with persistent AKI (MACE: adjusted HR: 2.32; 95% CI: 1.48-3.64; P < 0.001; NACE: adjusted HR: 2.29; 95% CI: 1.48-3.52; P < 0.001), driven mainly by all-cause mortality (adjusted HR: 3.43; 95% CI: 2.03-5.82; P < 0.001), whereas transient AKI was not associated with higher rates of MACE or NACE. Results remained consistent when implementing the KDIGO (Kidney Disease Improving Global Outcomes) criteria.

Conclusions: Among patients with ACS undergoing invasive management, in-hospital persistent but not transient AKI was associated with higher risk for 30-day MACE and NACE. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox [MATRIX]; NCT01433627).

Keywords: acute coronary syndrome; percutaneous coronary intervention; persistent acute kidney injury; transient acute kidney injury.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Acute Coronary Syndrome* / diagnostic imaging
Acute Coronary Syndrome* / therapy
Acute Kidney Injury* / diagnosis
Acute Kidney Injury* / epidemiology
Acute Kidney Injury* / etiology
Hemorrhage / chemically induced
Humans
Myocardial Infarction* / etiology
Percutaneous Coronary Intervention*
Risk Factors
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01433627