Transient vs In-Hospital Persistent Acute Kidney Injury in Patients With Acute Coronary Syndrome

• DOI: 10.1016/j.jcin.2022.10.009
• Publication Date: 2022-12-28T19:15:49Z
• Authors: Antonio Landi; Mattia Branca; Sergio Leonardi; Enrico Frigoli; Pascal Vranckx; Matteo Tebaldi; Ferdinando Varbella; Paolo Calabró; Giovanni Esposito; Gennaro Sardella; Stefano Garducci; Giuseppe Andò; Ugo Limbruno; Paolo Sganzerla; Andrea Santarelli; Carlo Briguori; Salvatore Colangelo; Salvatore Brugaletta; Marianna Adamo; Elmir Omerovic; Dik Heg; Stephan Windecker; Marco Valgimigli
• Keywords: percutaneous coronary intervention; Myocardial Infarction; Hemorrhage; persistent acute kidney injury; Acute Kidney Injury; acute coronary syndrome; percutaneous coronary intervention; persistent acute kidney injury; transient acute kidney injury; acute coronary syndrome; 3. Good health; 03 medical and health sciences; Percutaneous Coronary Intervention; Treatment Outcome; 0302 clinical medicine; transient acute kidney injury; Risk Factors; Humans; Acute Coronary Syndrome; persistent acute kidney injury; acute coronary syndrome; transient acute kidney injury; percutaneous coronary intervention

The occurrence of acute kidney injury (AKI) among patients with acute coronary syndrome (ACS) undergoing invasive management is associated with worse outcomes. However, the prognostic implications of transient or in-hospital persistent AKI may differ.The aim of this study was to evaluate the prognostic implications of transient or in-hospital persistent AKI in patients with ACS.In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial, 203 subjects were excluded because of incomplete information or end-stage renal disease, with a study population of 8,201 patients. Transient and persistent AKI were defined as renal dysfunction no longer or still fulfilling the AKI criteria (>0.5 mg/dL or a relative >25% increase in creatinine) at discharge, respectively. Thirty-day coprimary outcomes were the out-of-hospital composite of death, myocardial infarction, or stroke (major adverse cardiovascular events [MACE]) and net adverse cardiovascular events (NACE), defined as the composite of MACE or Bleeding Academic Research Consortium type 3 or 5 bleeding.Persistent and transient AKI occurred in 750 (9.1%) and 587 (7.2%) subjects, respectively. After multivariable adjustment, compared with patients without AKI, the risk for 30-day coprimary outcomes was higher in patients with persistent AKI (MACE: adjusted HR: 2.32; 95% CI: 1.48-3.64; P < 0.001; NACE: adjusted HR: 2.29; 95% CI: 1.48-3.52; P < 0.001), driven mainly by all-cause mortality (adjusted HR: 3.43; 95% CI: 2.03-5.82; P < 0.001), whereas transient AKI was not associated with higher rates of MACE or NACE. Results remained consistent when implementing the KDIGO (Kidney Disease Improving Global Outcomes) criteria.Among patients with ACS undergoing invasive management, in-hospital persistent but not transient AKI was associated with higher risk for 30-day MACE and NACE. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox [MATRIX]; NCT01433627).