Predictors of acute kidney injury rates in patients admitted with ST-elevation myocardial infarctions complicated by cardiogenic shock

Abstract Introduction Prior studies have shown that the main contributor to acute kidney injury (AKI) in patients with ST-elevation myocardial infarctions (STEMI) could rather be the STEMI itself or hemodynamic sequelae and to a lesser extent, contrast media (CM) induced toxicity. However, there is few data on predictors of AKI in patients with STEMI and cardiogenic shock (CS), especially about the possible harmful effect of CM. Aim of the present study was therefore to investigate how higher amounts of CM affected AKI-rates in patients admitted with STEMI complicated by CS and how they compared with interventional success rates. Methods All patients admitted with STEMI complicated by CS to a large German PCI center admitted between 2006 and 2022 were analysed for this study. To allow adequate diagnosis of AKI, all patients with a hospital stay of 48 hours in the PCI center were excluded. AKI was defined by KDIGO criteria. Patients were stratified by amount of CM they received: G1:≤100 ml, G2: 101-150 ml, G3: 151-200 ml, G4 201-250 ml, G5: 251-300 ml, G6300 ml. Results A total of 1147 with STEMI complicated by CS were included in the study with a mean age of 63.8±12 yrs., 278 (24%) were women. They received an average of 154.7±74 ml of contrast media, G1: 79.2±20ml, G2: 128.9±14 ml, G3: 178.3±15 ml, G4: 228.6±15 ml, G5: 280.8±15, G6: 362.5±70 ml. AKIN 1 could be detected in 35.5% of patients, severe kidney failure (AKIN 3) in 11.7%. A univariate analysis showed that excess amounts of CM-media were associated with higher AKIN-1-rates: G1: 32.5%, G2: 30.4%, G3: 36.8%, G4: 46.6%, G5: 42.8%, G6: 45.6%, p(trend):0.01. However, when adjusting this analysis for confounders (age, gender, diabetes, multivessel disease, peak CK, LV-EF40%, PCI result, in-hospital resucitations, in hospital bleedings) even high or very high amounts of CM were not independently associated with a higher likelihood for AKIN-1 : G4 (vs. G1): OR, 1.2, 95% CI 0.9-3.8, p=0.576; G5 (vs.G1): OR 1.82, 95% CI 0.9-3.7, p=0.112; G6 (vs. G1): OR 1.18, 95% CI 0.4-3.2, p=0.737. When setting the cut-off at CM 200 ml in a multivariate model again higher CM-amounts were not independently associated with a higher risk of AKIN-1 or AKIN3, while an optimal interventional result was associated with a lower risk for AKIN-1 or AKIN 3 (table). Conclusions In patients admitted with STEMI complicated by CS AKI could be observed in more than 35% of patients and severe kidney failure in 11.7%. When adjusting for confounders, even very high amounts of CM were not independently associated with a higher risk of kidney damage, while an optimal interventional result was associated with a lower risk. This indicates that PCI-success in CS patients may play a decisive role in preventing kidney damage.Predictors of AKIN 1 and 3 in CS*