Risk Factors for Acute Kidney Injury in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract

Background Acute Kidney Injury (AKI) is a prominent complication of ACS, is more prevalent in STEMI, and can be a predictive indicator of long-term death. The frequency of AKI in patients with STEMI ranges between 10 and 20 percent, and the presence of AKI has a significant impact on in-hospital clinical results and long-term outcomes. Aim Form the basis for clinical considerations for the cost-effectiveness of treating STEMI with Acute Kidney Injury after undergoing primary percutaneous coronary intervention (PCI). Methods This cohort retrospective study of 597 STEMI patients who underwent Primary PCI from 2017 to July 2022 at Saiful Anwar General Hospital Malang. There were 568 patients included, 29 patients were excluded. We conducted both univariate and multivariate studies to determine AKI risk factors. By comparing the area under the curve, the receiver operating characteristic curves were compared (AUC). The number of positive variables for which the sensitivity and specificity were established. Using SPSS 26.0, data were examined. Results In terms of familial CAD risk factors, there was a statistically significant difference between the two patient groups with p= 0.020. In the clinical condition of shock (p = 0.000); IMA location p = 0.019; Killip classification (p = 0.000). The laboratory parameters that are significant between the two groups to be a risk factor for incidence of acute kidney injury include Random Blood Sugar (RBS) with p value = 0.000. The results of cardiac catheterization in culprit lesions showed significant results for the incidence of AKI in STEMI patients undergoing primary PCI with p-value = 0.000; TIMI flow (p = 0.000); and total volume contrasts (p = 0.000). This variable, with p value < 0.05, is an independent risk factor for the incidence of AKI in STEMI patients undergoing primary PCI. Furthermore, multivariate analysis with logistic regression was performed on these variables. From multivariate analysis with logistic regression, result of the odds ratio value (OR) of each variable was obtained for the incidence of AKI. The OR values for each were as follows: Shock condition (OR = 1.41; 95% CI 1.18 – 1.92); Killip 3 (OR = 3.54; 95% CI 2.14 – 4.26); LAD culprit lesions (OR = 0.34; 95% CI 0.27 – 0.68); and total volume contrast > 145 ml (OR = 1.61; 95% CI 1.13 – 1.92). Based on the ROC curve above, the total volume contrast > 145 ml is independent risk factor with an Area under curve (AUC) of 0.75 (95% CI 0.65-0.85); a sensitivity of 0.71 (95% CI 0.0.65-0.76) and a specificity of 0.66 (95% CI 0.61 – 0.71 ).