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

PLOS ONE, Dec 2019

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). 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) from the INTERSTELLAR 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.)

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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 - 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)


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Sang-Don Park, Jeonggeun Moon, Sung Woo Kwon, Young Ju Suh, Tae-Hoon Kim, Ho-Jun Jang, Jon Suh, Hyun Woo Park, Pyung Chun Oh, Sung-Hee Shin, Seong-Il Woo, Dae-Hyeok Kim, Jun Kwan, WoongChol Kang. 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, PLOS ONE, 2016, Volume 11, Issue 7, DOI: 10.1371/journal.pone.0159416