Frequency of Acute Kidney Injury in Patients Presenting with Acute ST-Elevation Myocardial Infarction and Its Relationship with In-Hospital Mortality

Abstract

Objective: To determine the frequency of acute kidney injury in patients presenting with acute ST elevation myocardial infarction and to compare the frequency of in-hospital mortality between patients presenting with acute ST elevation myocardial infarction with versus without acute kidney injury at a tertiary care hospital.

Design: It was a descriptive case series.

Study Settings: Department of Cardiology, Shaikh Zayed Hospital Lahore-Pakistan over a period of 6 months from January 2021 to June 2021.

Material and Methods: A total of 128 patients of both genders aged between 18-70 years presenting with in first 12 hours of acute STEMI at emergency ward of cardiology department were included in this descriptive case series study. An informed written consent was taken from all the participants. All these patients were managed as per standard departmental protocols. Renal function was assessed within 30 minutes of presentation and then after 72 hours of admission and acute kidney injury was labelled if there was ≥0.5 mg/dl increase in serum creatinine level from baseline. These patients were followed till discharge and death of the patient during hospital stay was noted. It was then compared between patients with versus without acute kidney injury.

Results: The patients had mean age of 53.8±11.3 years. There were 86 (67.2%) males and 42 (32.8%) females with a male to female ratio of 2.1:1. 97 (75.8%) patients were obese, 65 (50.8%) patients were diabetic and 87 (68.0%) patients were hypertensive. 72 (56.3%) patients were active smokers. 25 (19.5%) patients with acute STEMI developed acute kidney injury while 10 (7.8%) patients died during hospital stay. The frequency of in-hospital mortality was significantly higher in acute STEMI patients with AKI as compared to those without AKI (24.0% vs. 3.9%; p-value=0.004). When compared similar difference was noted in in-hospital mortality between acute STEMI patients with versus without AKI across various subgroups based on age, gender, BMI, diabetes, hypertension, smoking, ASA status, thrombolysis and need for PCI.

Conclusion: A substantial proportion of patients presenting with acute ST-segment elevation myocardial infarction developed acute kidney injury that was associated with increased frequency of mortality among such patients which warrants routine monitoring of renal function among patients presenting with acute ST-segment elevation myocardial infarction and consideration of cases positive of AKI at higher risk of mortality so that risk stratification and anticipated management may improve the outcome of such patients in future practice.

Keywords: Acute ST Elevation Myocardial Infarction, Acute Kidney Injury, In-Hospital Mortality.