Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission

Objective: To evaluate the clinical and prognostic relevance of acute kidney injury (AKI) in the setting of ST-elevation acute myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Design: Prospective study. Setting: Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center. Patients: Ninety-seven consecutive STEMI patients with CS at admission, undergoing intra-aortic balloon pump (IABP) support and primary percutaneous coronary intervention (PCI). Interventions: None. Measurements and Main Results: We measured serum creatine at baseline and each day for the following 3 days. Acute kidney injury was defined as a rise in creatinine > 25% from baseline. Overall, AKI occurred in 52 (55%) patients, and in 12 of these patients, a renal replacement therapy was required. In multivariate analysis, age > 75 yrs (p = .005), left ventricular ejection fraction <= 40% (p = .009), and use of mechanical ventilation (p = .01) were independent predictors of AKI. Patients developing AKI had a longer hospital stay, a more complicated clinical course, and significantly higher mortality rate (50% vs. 2.2%; p < .001) than patients without AKI. In our population, AKI was the strongest independent predictor of in-hospital mortality (relative risk 12.3, 95% confidence intervals 1.78 to 84.9; p < .001). Conclusions: In patients with STEMI complicated by CS, AKI represents a frequent clinical complication associated with a poor prognosis. (Crit Care Med 2010; 38:438-444)