Prognostic Significance of Acute Kidney Injury After Reperfused ST-Elevation Myocardial Infarction: Synergistic Acceleration of Renal Dysfunction and Left Ventricular Remodeling

Anzai, Atsushi; Anzai, Toshihisa; Naito, Kotaro; Kaneko, Hidehiro; Mano, Yoshinori; Jo, Yusuke; Nagatomo, Yuji; Maekawa, Yuichiro; Kawamura, Akio; Yoshikawa, Tsutomu; Ogawa, Satoshi

doi:10.1016/j.cardfail.2009.12.020

« Previous Next »Journal of Cardiac Failure
Volume 16, Issue 5 , Pages 381-389, May 2010

Prognostic Significance of Acute Kidney Injury After Reperfused ST-Elevation Myocardial Infarction: Synergistic Acceleration of Renal Dysfunction and Left Ventricular Remodeling

Atsushi Anzai, MD
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
Toshihisa Anzai, MD, FACC
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Reprint requests: Toshihisa Anzai, MD, FACC, Division of Cardiology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Tel: + 81-3-5363-3793, Fax: + 81-3-3353-2502
Kotaro Naito, MD
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
Hidehiro Kaneko, MD
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
Yoshinori Mano, MD
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
Yusuke Jo, MD
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
Yuji Nagatomo, MD
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
Yuichiro Maekawa, MD
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
Akio Kawamura, MD
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
Tsutomu Yoshikawa, MD, FACC
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
Satoshi Ogawa, MD, FACC
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

Received 19 June 2009; received in revised form 18 December 2009; accepted 30 December 2009. published online 12 February 2010.

Abstract

Background

Acute kidney injury (AKI) after myocardial infarction is associated with poor clinical outcome. However, mechanisms of the adverse effect of AKI on clinical outcome after reperfused ST-elevation myocardial infarction (STEMI) have not been fully elucidated.

Methods and Results

We examined 141 consecutive patients with reperfused first anterior STEMI. AKI was defined as an increase in serum creatinine of ≥0.3mg/dL within 48hours after admission. Patients with AKI had higher incidence of in-hospital cardiac death (P=.0004) and major adverse cardiac events (MACE, P=.020) during a mean of 39±40 (range, 1 to 96) months than those without, in association with adverse left ventricular (LV) remodeling. White blood cell count on admission and peak C-reactive protein were higher in patients with than those without AKI. Plasma norepinephrine on admission, interleukin-6, brain natriuretic peptide, and malondialdehyde-modified low-density lipoprotein 2 weeks after STEMI were higher in patients with AKI than those without AKI. Cox proportional hazards model analysis revealed AKI was an independent predictor of MACE (hazard ratio=2.38, P=.019).

Conclusions

AKI was a strong predictor of MACE in association with adverse LV remodeling. Enhanced inflammatory response, oxidative stress, and neurohormonal activation may synergistically accelerate renal dysfunction and LV remodeling after STEMI.

Key Words: Kidney, heart failure, inflammation, oxidative stress