Prognostic Impact of Combined Contrast-Induced Acute Kidney Injury (CI-AKI) and Hypoxic Liver Injury (HLI) in Patients with ST Elevation Myocardial Infarction (STEMI) Who Underwent Primary PercutaneousCoronary Intervention (PCI) : Results from the INTERSTELLAR Registry

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.