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

https://doi.org/10.1016/j.jcin.2022.10.009Get rights and content
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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)

Key Words

acute coronary syndrome
percutaneous coronary intervention
persistent acute kidney injury
transient acute kidney injury

Abbreviations and Acronyms

ACS
acute coronary syndrome
AKI
acute kidney injury
BARC
Bleeding Academic Research Consortium
CKD
chronic kidney disease
eGFR
estimated glomerular filtration rate
MACE
major adverse cardiovascular event(s)
MI
myocardial infarction
NACE
net adverse clinical event(s)
NSTEMI
non-ST-segment elevation myocardial infarction
PCI
percutaneous coronary intervention
SCr
serum creatinine
UFH
unfractionated heparin

Cited by (0)

John Bittl, MD, served as Guest Editor for this paper.

H. Vernon “Skip” Anderson, MD, served as Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.