Prognostic Impact of Combined Contrast-Induced Acute Kidney Injury and Hypoxic Liver Injury in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Results from INTERSTELLAR Registry
July
Prognostic Impact of Combined Contrast- Induced Acute Kidney Injury and Hypoxic Liver Injury in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Results from INTERSTELLAR Registry
Sang-Don Park 0 1
Jeonggeun Moon 1
Sung Woo Kwon 0 1
Young Ju Suh 1
Tae- Hoon Kim 1
Ho-Jun Jang 1
Jon Suh 1
Hyun Woo Park 1
Pyung Chun Oh 1
Sung-Hee Shin 0 1
Seong-Il Woo 0 1
Dae-Hyeok Kim 0 1
Jun Kwan 0 1
WoongChol Kang 1
0 Department of Cardiology, Inha University Hospital , Incheon , Republic of Korea, 2 Department of Cardiology, Gil Medical Center, Gachon University , Incheon , Republic of Korea, 3 Department of Biomedical Sciences, Inha University School of Medicine, Incheon, Republic of Korea, 4 Department of Cardiology, Sejong General Hospital , Bucheon , Republic of Korea, 5 Department of Cardiology, Soon Chun Hyang University Bucheon Hospital , Bucheon , Republic of Korea
1 Editor: Ingo Ahrens, University Hospital Medical Centre , GERMANY
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OPEN ACCESS
Data Availability Statement: All relevant data are
within the paper and its Supporting Information files.
Funding: This work was supported by INHA
UNIVERSITY Research Grant (INHA-51457). The
funder had no role in study design, data collection
and analysis, decision to publish, or preparation of
the manuscript.
Competing Interests: The authors have declared
that no competing interests exist.
Background
Methods
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). We sought to evaluate the prognostic impact of CI-AKI and HLI in
STEMI patients who underwent primary percutaneous coronary intervention (PCI).
A total of 668 consecutive patients (77.2% male, mean age 61.3±13.3 years) from the INTER
STELLAR STEMI registry who underwent primary PCI were analyzed. CI-AKI was defined as
an increase of
0.5 mg/dL in serum creatinine level or 25% relative increase, within 48h after
the index procedure. HLI was defined as
2-fold increase in serum aspartate transaminase
above the upper normal limit on admission. Patients were divided into four groups according
to their CI-AKI and HLI states. Major adverse cardiovascular and cerebrovascular events
(MACCE) defined as a 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, 94 MACCEs occurred with an event rate of 14.1%. The rates of MACCE and all-cause mortality were 9.7% and 5.2%, respectively, in
the 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. Survival probability plots
of composite MACCE and all-cause mortality revealed that the combined CI-AKI and HLI
group was associated with the worst prognosis (p<0.0001 for both).
Conclusion
Combined CI-AKI after index procedure and HLI on admission is associated with poor clinical outcomes in patients with STEMI who underwent primary PCI. (INTERSTELLAR
ClinicalTrials.gov number, NCT02800421.)
Introduction
Even after successful primary percutaneous coronary intervention (PCI), both the short and
long term prognoses of patients with ST-elevation myocardial infarction (STEMI) are
considerably poor [
1,2
]. Conventional risk factors, including diabetes mellitus, are known to be
associated with worse outcomes in these patients [3]. Left ventricular ejection fraction (LVEF) and
Killip class on admission, as well as multi-vessel disease (MVD) are also well-known
parameters suspected of contributing to poorer prognosis [
4,5
]. Since adscititious vital organ damage
may affect the survival of patients with STEMI, previous studies have revealed the importance
of contrast-induced acute kidney injury (CI-AKI) in interventionally-treated patients with
STEMI, in terms of prognosis [
6–9
]. A recent study had also proposed the prognostic impact
of hypoxic liver injury (HLI) among patients with STEMI [
10
]. However, there is lack of data
regarding the prognostic value of combined CI-AKI and HLI among patients with STEMI.
Therefore, we sought to evaluate the prognostic impact of CI-AKI and HLI in patients with
STEMI who underwent primary PCI.
Materials and Methods
Study design and patient selection
This was a multi-center study that consisted of 4 hospitals (Inha University Hospital, Gachon
University Gil Medical Center, Sejong General Hospital, and Soon Chun Hyang University Bucheon
Hospital) in the Incheon-Bucheon province. These 4 hospital established a STEMI registry
designated as INTERSTELLAR (INcheon-Bucheon cohorT of patients who undERwent primary PCI
for acute ST-Elevation myocardial infARction) [
11
]. From the INTERSTELLAR registry cohort, a
total of 668 consecutive patients (77.2% male, mean age 61.3±13 (...truncated)