Abstract 13296: Impact of Microvascular Dysfunction on the Incidence of Acute Kidney Injury and In-Hospital Suvival After Primary Coronary Intervention for Acute Myocardial Infarction
Background: Recent studies have shown that severe microvascular dysfunction (MVD) is a strong predictor of future mortality in patients with acute myocardial infarction (AMI). Acute kidney injury (AKI) is a relatively common complication of illness and associated with in-hospital mortality in critically ill patients. However, the relationship between MVD and AKI has not been evaluated. The aim of this study was to determine the relationship between MVD and AKI, and whether the incidence of AKI added prognostic value on in-hospital mortality in patients with AMI.
Methods: The study population consisted of 194 consecutive patients with a first anterior AMI successfully treated with primary percutaneous coronary intervention (PCI). Patients with baseline serum creatinine >2.5mg/dl were excluded from this study. We examined the CFV pattern immediately after PCI using a Doppler guidewire. According to our previous reports, we defined MVD as a diastolic deceleration time ≤600 ms and the presence of systolic flow reversal. Patients were divided into two groups: those without MVD (n=129; group 1) and those with MVD (n=65; group 2). AKI was defined by an absolute increase of serum creatinine >0.3 mg/dl or a relative increase of >50% in serum creatinine measured 2 to 4 days after primary PCI.
Results: The baseline creatinine concentrations are comparable between two groups. The incidence of AKI was more frequently observed in group 2 compared with group 1 (17% vs 4%, P=0.018). All of the 8 in-hospital deaths occurred in group 2. The in-hospital mortality rate was significantly higher patients with AKI than those without AKI in group 2 (55% vs 4%, P<0.0001).
Conclusions: AKI was more frequently occurred in patients with MVD after primary PCI than those without MVD. The incidence of AKI is a critical prognostic indicator in AMI patients with MVD after primary PCI.
- © 2010 by American Heart Association, Inc.