Prognostic Impact of Combined Contrast-Induced Acute Kidney Injury (CI-AKI) and Hypoxic Liver Injury (HLI) in patients with ST Elevation Myocardial Infarction (STEMI) undergoing Primary Percutaneous Coronary Intervention (PCI) : Data from INTERSTELLAR Cohort

초록

Objectives: We sought to evaluate the prognostic impact ofcontrast-induced acute kidney injury (CI-AKI) and hypoxic liver injury (HLI) in patients with ST-elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PCI). Methods: From 2007 to 2014, a total of 667consecutive patients (77.2% male, mean age 61.3±13.3 years) with STEMI underwent primary PCI were analyzed. CI-AKI was defined as an increase in serum creatinine of ≥0.5 mg/dl or a 25% relative rise, within 48h after index procedure. HLI was defined as ≥2-fold increase of serum aminotransferase above upper normal limit at admission. Patients were divided into four groups according to their CI-AKI and HLI states (group I: no CI-AKI and no HLI, group 2: only HLI, group 3: only CI-AKI, group 4: both CI-AKI and HLI). The primary endpoint was major adverse cardiac events (MACE) during follow-period, defined as all-cause mortality or non-fatal MI. Results: Of the 667 patients, 465 patients (69.7%) were allocated in group 1; 129 patients (19.3%) in group 2; 47 patients (7.0%) in group 3 and 26 patients (3.9%) in group 4. Over a mean follow-up period of 2.2±1.6 years, there were 65 MACEs (42 all-cause mortality and 23 non-fatal MI) with an event rate of 9.7%. The rate of MACE and all-cause mortality were 5.2% and 3.4% in group 1, 14.0% and 10.1% in group 2, 21.3% and 6.4% in group 3, and 50.0% and 38.5% in group 4, respectively. Consequently, Kaplan-Meier survival analysis for MACE and all-cause mortality revealed that group 4 was associated with worst clinical outcomes (log rank p-value< 0.0001). Conclusions: Combined CI-AKI after index procedure and HLI at admission is associated with poor clinical outcomes in patients with STEMI underwent primary PCI. Figure. Survival probability plot of (a) MACE and (b) all-cause mortality according to CI-AKI and HLI state after adjustment for age, diabetes, hypertension, MVD, Killip class, and LVEF