Acute kidney injury in acute coronary syndromes – An important multifactorial consequence

Abstract

Introduction: Acute kidney injury (AKI) is a pathological phenomenon with a negative impact on outcomes in different clinical scenarios. Its mechanism in acute coronary syndrome (ACS) is not completely understood, and measures to prevent it are not uniform. We set out to study the incidence, clinical relevance, predictors and possible implications for patient management of AKI in ACS. Methods: Using data from a multicenter national registry on ACS, we retrospectively analyzed predictors of AKI and its impact on outcomes (in-hospital complications and one-year mortality). All ACS types were included. AKI was defined as an increase in serum creatinine of ≥0.3 mg/dl (≥26.4 μmol/l) and/or by ≥1.5 times baseline. Results: A total of 7808 ACS patients were included in the analysis, 1369 (17.5%) of whom developed AKI. AKI was shown to be an independent predictor of in-hospital major bleeding (odds ratio [OR] 2.09; 95% confidence interval [CI] 1.19-3.64; p=0.01), mortality (OR 4.72; 95% CI 2.94-7.56; p1 on admission and left ventricular ejection fraction 1 na admissão e fração de ejeção ventricular esquerda <50%. A realização de coronariografia ou angioplastia não se associaram a um aumento de LRA. A utilização de diuréticos foi preditora de LRA apenas em doentes KK 1. Conclusões: A LRA é um achado importante no contexto de SCA, com impacto clínico significativo, nomeadamente mortalidade intra-hospitalar e a um ano. A LRA associa-se a características clínicas facilmente identificáveis e a estratégia invasiva não aumenta a sua incidência. Keywords: Acute coronary syndrome, Acute kidney injury, Coronary angiography, Percutaneous coronary intervention, Contrast media, Palavras-chave: Síndrome coronária aguda, Lesão renal aguda, Coronariografia, Angioplastia coronária, Meios de contraste