Abstract 13402: Racial Differences in Incidence of Acute Kidney Injury in Patients With ST-Elevation Myocardial Infarction

Abstract

Background: Racial differences in outcomes of STEMI patients continue to persist. Our study aimed to assess the difference in the incidence of acute kidney injury (AKI) post percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI), stratified by race into African Americans (AA) vs Caucasians. Methods: All STEMI patients who underwent PCI at the Cleveland Clinic main campus between January 1, 2011, to July 15, 2019, were included in our study. Patients were categorized into two groups depending on a diagnosis of the presence or absence of AKI post PCI. AKI was defined as >0.3mg/dl rise in post PCI creatinine from pre-procedure value. Relative risk of developing AKI depending on race was calculated with the help of a two by two table. Results: Overall, 1847 patients were admitted to our hospital with a STEMI and underwent PCI during the study period. Of these, 267 (15%) developed AKI post PCI. 19% of AA patients developed AKI compared to 13% of Caucasian. Comparison of baseline characteristics amongst patients who developed AKI revealed that AA patients with AKI were younger than their Caucasian counterparts (median age 63 vs 68, p=0.006), but were more likely to having smoking history (52% vs 35%, p=0.014). Upon analyzing the association between race and AKI, AA patients were 48% more likely to develop AKI post PCI compared to Caucasian patients (RR of 1.48, 95% CI 1.17-1.86, p=0.0015). This difference was observed in spite of no significant differences in radial access, contrast dose, or mechanical circulatory support use between the two races. Conclusion: African Americans STEMI patients are almost 50% more likely than Caucasians to develop AKI post PCI. Developing race-specific process measures and further optimization of procedural characteristics may be necessary to improve the outcomes of AA STEMI patients.