SYNTAX Score of Infarct-Related Artery Other Than the Number of Coronary Balloon Inflations and Deflations as an Independent Predictor of Contrast-Induced Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction

• Published in: Acta Cardiologica Sinica Vol. 33; no. 4; pp. 362 - 376
• Main Authors: Liu, Cheng-Wei, Liao, Pen-Chih, Chen, Kuo-Chin, Hsu, Jung-Cheng, Tu, Chung-Ming, Wu, Yen-Wen, Li, Ai-Hsien, Ke, Shin-Rong, Lin, Jiunn-Lee
• Format: Journal Article
• Language: English
• Published: China (Republic : 1949- ) 中華民國心臟學會 01.07.2017; Taiwan Society of Cardiology
• Subjects: Original; Percutaneous Coronary Intervention; Primary percutaneous coronary intervention; Acute myocardial infarction; Acute kidney injury
• ISSN: 1011-6842
• DOI: 10.6515/ACS20161130A

Background: Although remote ischemic post-conditioning (RIPC) has been shown to prevent contrast-induced acute kidney injury (CIAKI) in patients with acute coronary syndrome, its efficacy in patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. We examined the relationship among balloon inflations and deflations (BID) times, SYNTAX score of infarction-related artery (SI), periprocedural complications, and CIAKI in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). Methods: Patients with STEMI undergoing pPCI with Mehran risk score (MRS)≥ 5 were enrolled between February 2007 and September 2012. The study end point was the development of CIAKI. Results: Of 206 patients, the median age was 65 years [interquartile range (IQR): 55-77] with 72.8% male and Mehran risk score (MRS) 8 (IQR: 6-12). Receiver operating characteristic curve showed that BID times ＞ 9 times or SI ＞ 10was the best cut-off associated with CIAKI. In univariate analysis, significant associationwith CIAKI existed in BID ＞ 9 times [odds ratio (OR): 3.106, 95% confidence interval (CI): 1.284-7.513, p = 0.012] and SI ＞ 10 (OR: 3.909, 95% CI: 1.570-9.735, p = 0.003). Other variables associated with CIAKI included creatinine, hemoglobin, angiotensin converting enzyme inhibitor or angiotensin receptor blocker use at discharge. In multivariate analysis, SI ＞ 10 remained an independent predictor of CIAKI in different adjustment model, even on top of MRS (adjusted OR: 3.498, 95% CI: 1.086-11.268, p = 0.036). Conclusions: Vascular complexity of infarct-related artery rather than higher BID times (＞ 9) was the major determinant of the development of CIAKI after pPCI in STEMI patients.