Combined Contrast-Induced Acute Kidney Injury and Hypoxic Liver Injury Is Associated with Worse Outcome in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Results from INTERSTELLAR Registry

초록

Background Besides contrast-induced acute kidney injury (CI-AKI), adscititious vital organ damage such as hypoxic liver injury (HLI) may affect the survival in patients with ST-elevation myocardial infarction (STEMI). Therefore, we sought to evaluate the prognostic impact of CI-AKI and HLI in STEMI patients who underwent primary percutaneous coronary intervention (PCI). Methods A total of 668 consecutive patients (77.2% male, mean age 61.3±13.3 years) with STEMI underwent primary PCI were analyzed. CI-AKI was defined as increase in serum creatinine of ≥0.5 mg/dl or 25% relative rise, within 48h after index procedure. HLI was defined as ≥2-fold increase of serum aspartate transaminase above upper normal limit at admission. Patients were divided into four groups according to their CI-AKI and HLI states. Major adverse cardiovascular and cerebrovascular events (MACCE) defined as composite of all-cause mortality, non-fatal MI, non-fatal stroke, ischemia-driven target lesion revascularization and target vessel revascularization were recorded. Results Over a mean follow-up period of 2.2±1.6 years, there were 94 MACCEs with an event rate of 14.1%. The rate of MACCE and all-cause mortality were 9.7% and 5.2% in no organ damage group, 21.3% and 21.3% in CI-AKI group, 18.5% and 14.6% in HLI group, and 57.7% and 50.0% in combined CI-AKI and HLI group, respectively. Survival probability plots of composite MACCE and all-cause mortality revealed that combined CI-AKI and HLI is associated with worst prognosis (p<0.0001 for both). Conclusion Combined CI-AKI after index procedure and HLI at admission is associated with poor clinical outcomes in patients with STEMI underwent primary PCI.