SYNTAX Score of Infarct-Related Artery Other Than the Number of Coronary Balloon Inflations and Deflations as an Independent Predictor of Contrast-Induced Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction

Impact of Acute Kidney Injury and Baseline Renal Impairment on Prognosis Among Patients Undergoing Percutaneous Coronary Intervention

BACKGROUND

Both chronic kidney disease (CKD) and acute kidney injury (AKI) are associated with adverse consequences among patients undergoing percutaneous coronary intervention (PCI). However, it remains undetermined whether the impact of CKD and post-PCI AKI are similar. We aimed to discriminate between the impact of CKD and post-PCI AKI on short- and long-term outcomes.

METHODS

This retrospective cohort study included 1,100 patients undergoing PCI at a tertiary hospital. Based on baseline kidney function, patients were categorized as having preserved or impaired renal function, defining as an estimated glomerular filtration rate (eGFR) of ≥ and < 45 ml/min/1.73 m², respectively. Post-PCI AKI was defined as ≥ 100% relative increase between baseline and post-procedural serum creatinine.

RESULTS

Post-PCI AKI was associated with an increased risk of 90-day mortality [odds ratio (OR): 22.03, 95% confidence interval (CI): 10.36-46.88], long-term mortality [hazard ratio (HR): 6.63, 95% CI: 4.31-10.20], and composite endpoint of future end-stage renal disease (ESRD) and death (HR: 6.19, 95% CI: 4.06-9.42). Impaired kidney function at baseline was associated with an increased risk of future ESRD and composite endpoint of ESRD and death (for every 10 unit increase in eGFR, HR: 0.25, 95% CI: 0.14-0.43, and HR: 0.89, 95% CI: 0.82-0.97, respectively). The impact of post-PCI AKI outweighed that of impaired baseline renal function on short- and long-term prognosis. Patients with impaired baseline renal function who developed AKI following PCI had the worst prognosis.

CONCLUSIONS

Both post-PCI AKI and CKD were associated with a poor prognosis. Post-PCI AKI was more important than baseline renal function to predict long-term mortality and composite outcomes. The systemic pathophysiologic change accompanying AKI, rather than renal function per se, may play a crucial role.

Retinal Vascular Density as A Novel Biomarker of Acute Renal Injury after Acute Coronary Syndrome

Iodinated contrast agent (ICA)-induced acute kidney injury (AKI) following acute coronary syndrome (ACS) is a frequent complication, which may lead to chronic kidney disease and increased mortality. Optical coherence tomography angiography (OCT-A) of the retina is new tool delivering a rapid and noninvasive assessment of systemic microvascularization, which is potentially involved in the occurrence of ICA-induced AKI. Between October 2016 and March 2017, 452 ACS patients were admitted to our cardiac intensive care unit. OCT-A was performed within 48 h after the ICA injection. Patients with a history of retinal disease were excluded. The patients included were divided into two groups depending on whether or not AKI occurred after injection of ICA, according to KDIGO criteria. Of the 216 patients included, 21 (10%) presented AKI. AKI was significantly associated with age, Mehran score, GRACE score, and NT-proBNP. AKI patients had significantly lower retinal vascular density (RVD)) and had more frequent low RVD (81% vs 45%, P = 0.002). Adding low RVD to the Mehran score and the NT-proBNP, or to the GRACE score and the NT-proBNP, significantly improved their predictive values, suggesting that systemic microvascular involvement remains incompletely addressed by either standard risk scores or factors known to be associated with ICA-induced AKI.

Relationship between ST-Segment Shifts in Lead aVR and Coronary Complexity in Patients with Acute Coronary Syndrome

BACKGROUND

ST-segment shifts in lead aVR are associated with increased coronary atherosclerosis. However, there is insufficient data about the relationship between ST-segment shifts in lead aVR and coronary complexity. The aim of this study was to investigate this relationship.

METHODS

This prospective, observational study included 236 patients with acute coronary syndrome who underwent coronary angiography. Electrocardiograms on presentation were reviewed in terms of ST-segment shifts in lead aVR. Inter-observer agreement was analyzed using kappa statistics for the presence of aVR lead ST segment shifts. The patients were divided into two groups according to their Sx scores (≤ 22 and > 22).

RESULTS

The mean age of the study population was 62.19 ± 12 years. Eighty-seven patients (37%) had complex coronary artery disease as defined by intermediate-high Sx scores, and 130 patients (55%) had ST-segment shifts in lead aVR. In multivariate logistic regression analysis, ST-segment elevation or depression ≥ 1 mm were independently associated with intermediate-high Sx scores.

CONCLUSIONS

In patients with acute coronary syndrome, the presence of ST-segment elevation or depression ≥ 1 mm in lead aVR may indicate coronary complexity.