Abstract
Purpose Cardiogenic shock (CS) is the leading cause of death in patients with acute myocardial infarction (AMI). Our study aimed to evaluate the short-term prognostic value of admission blood urea nitrogen (BUN) in patients with CS complicating AMI. Materials and Methods 218 consecutive patients with CS after AMI were enrolled. The primary endpoint was 30-day mortality. The association of admission BUN and 30-day mortality and major adverse cardiovascular event (MACE) was investigated by Cox regression. The integrated discrimination improvement (IDI) and net reclassification improvement (NRI) further examined the predictive value of BUN. Results During a period of 30-day follow-up, 105 deaths occurred. Compared to survivors, nonsurvivors had significantly higher admission BUN (p < 0.001), creatinine (p < 0.001), BUN/creatinine (p = 0.03), and a lower glomerular filtration rate (p < 0.001). The area under the curve (AUC) of the 4 indices for predicting 30-day mortality was 0.781, 0.734, 0.588, and 0.773, respectively. When compared to traditional markers associated with CS, the AUC for predicting 30-day mortality of BUN, lactate, and left ventricular ejection fraction were 0.781, 0.776, and 0.701, respectively. The optimal cut-off value of BUN for predicting 30-day mortality was 8.95 mmol/L with Youden-Index analysis. Multivariate Cox analysis indicated BUN >8.95 mmol/L was an important independent predictor for 30-day mortality (HR 2.08, 95%CI 1.28–3.36, p = 0.003) and 30-day MACE (HR 1.85, 95%CI 1.29–2.66, p = 0.001). IDI (0.053, p = 0.005) and NRI (0.135, p = 0.010) showed an improvement in the accuracy for mortality prediction of the new model when BUN was included compared with the standard model of predictors in previous scores. Conclusion An admission BUN >8.95 mmol/L was robustly associated with increased short-term mortality and MACE in patients with CS after AMI. The prognostic value of BUN was superior to other renal markers and comparable to traditional markers. This easily accessible index might be promising for early risk stratification in CS patients following AMI.
Highlights
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is a high-acuity and complex state of end-organ hypoperfusion that is frequently associated with multisystem organ failure
Routine parameters used for evaluating patients’ renal function usually include blood urea nitrogen (BUN), creatinine, glomerular filtration rate (GFR), and sometimes the ratio of BUN and creatinine [6]. While both BUN and creatinine are filtrated through the glomerulus and can reflect GFR, only BUN is reabsorbed from the tubules [6, 7]
CS was defined as the systolic blood pressure (SBP)
Summary
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is a high-acuity and complex state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Routine parameters used for evaluating patients’ renal function usually include blood urea nitrogen (BUN), creatinine, glomerular filtration rate (GFR), and sometimes the ratio of BUN and creatinine [6]. While both BUN and creatinine are filtrated through the glomerulus and can reflect GFR, only BUN is reabsorbed from the tubules [6, 7]. BUN has been shown to be an independent predictor of postdischarge all-cause mortality in elderly patients with acute decompensated heart failure, and its prognostic performance was similar to that of B-type natriuretic peptide (BNP) [9]. The present study aimed to evaluate the admission BUN in CS complicating AMI for prognostic relevance and to compare its predictive value with renal biomarkers and other well-acknowledged predictors in this population
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