Acute kidney injury in patients with myocardial infarction and percutaneous coronary interventions: laboratory markers and the influence on the frequency of recurrent cardiovascular events

Abstract

Highlights. Biomarkers of acute kidney injury and their effect on the frequency of recurrent coronary events in patients with myocardial infarction after percutaneous coronary interventions.Aim. To study biomarkers of acute kidney injury (AKI) and prognosis, as well as the frequency of recurrent cardiovascular events in patients with myocardial infarction and percutaneous coronary interventions.Methods. 166 patients with myocardial infarction and performed percutaneous coronary interventions were studied, divided into 2 groups: with acute kidney injury (n = 91) and without it (n = 50), the control group consisted of 25 people. All patients underwent standard general clinical and biochemical blood tests to assess the level of C-reactive protein, markers of myocardial necrosis, natriuretic peptide (NTproBNP), microalbuminuria (MAU). In both groups, the glomerular filtration rate (GFR) was calculated using the CKD-EPI formula. An increase in serum creatinine by 26.5 mmol/L or more during the first 3 days from the value at admission was the reason for the study of the level of Kidney Injury Molecule-1 (KIM-1) and interleukin 18 (IL-18) in urine on the 3rd and 14th days from hospitalization. All patients underwent coronary angiography and stenting of the infarct-dependent artery. 6 months and 1 year after discharge for this acute coronary event, repeated examinations of patients were performed to assess the frequency of repeated cardiovascular events and kidney function.Results. It was revealed that the creatinine level in the examined patients did not differ statistically significantly at admission, but there was a decrease in the filtration function of the kidneys in patients with AKI. On the third day of hospitalization, there was an increase in creatinine levels in the first group of patients with a decrease in GFR. The level of the KIM-1 and IL-18 molecules on the 3rd day of hospitalization in the first group was higher than the corresponding indicator of the comparison group. Also, patients with AKI showed a significant increase in the level of NTproBNP and MAU in the early period of kidney damage. When studying correlations, it was revealed that the level of MAU in the group with AKI is interrelated with the indicator of C-reactive protein and creatinine on the 3rd day of hospitalization. Also, a positive statistically significant correlation was found between the level of the KIM-1 molecule, IL-18, creatinine level on the 3rd day of hospitalization, NTproBNP and the level of MAU. During the follow-up of patients 6 months and a year after discharge, unstable angina pectoris, myocardial infarction, as well as progression of chronic heart failure were more often detected in the group with AKI. A persistent decrease in kidney function after a year was observed in most patients of the first group.Conclusion. The data obtained indicate the influence of acute kidney injury on the progression of renal dysfunction and the frequency of recurrent cardiovascular events, which is confirmed by the obtained associative relationships of the level of the KIM-1 molecule, creatinine and GFR with the prognosis of cardiovascular disease.