Premium
Relation of Pulmonary Artery Pressure and Renal Impairment in ST Segment Elevation Myocardial Infarction Patients
Author(s) -
Shacham Yacov,
GalOz Amir,
Topilsky Yan,
Keren Gad,
Arbel Yaron
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13206
Subject(s) - medicine , cardiology , ejection fraction , percutaneous coronary intervention , myocardial infarction , conventional pci , pulmonary artery , acute kidney injury , receiver operating characteristic , afterload , heart failure , blood pressure
Background Recent reports have demonstrated the adverse effects of venous congestion on renal function in patients having heart failure. None of the above trials, however, included patients with acute ischemia. Hypothesis Echocardiographic correlates of increased right ventricular afterload would be associated with an increased risk of acute kidney injury ( AKI ) in ST elevation myocardial infarction ( STEMI ) patients undergoing primary percutaneous coronary intervention ( PCI ). Methods We conducted a retrospective study of consecutive 930 STEMI patients who underwent primary PCI and had a full echocardiography study performed within 72 hours of hospital admission between June 2011 and December 2014. Results Echocardiography demonstrated that patients with AKI had significantly lower left ventricular ( LV ) ejection fraction, higher systolic pulmonary artery pressure ( SPAP ), and right atrial pressures (P < 0.001 for all). Following the performance of logistic multivariate analysis model, SPAP ( HR 1.07, 95% CI 1.04–1.11; P < 0.001) and LV ejection fraction ( HR 0.95, 95% CI 0.92–0.99; P = 0.03) emerged as independent predictors of AKI . On receiver operating characteristic ( ROC ) curve analysis, the optimal cutoff value of SPAP to predict AKI was measured as more than 32 mmHg, with 71% sensitivity and 62% specificity ( AUC 0.739, 95% CI 0.671–0.806, P < 0.001). Conclusions Among STEMI patients undergoing primary PCI , worse LV function and elevated SPAP were associated with increased risk of AKI .