Renal replacement therapy in patients with acute myocardial infarction: Rate of use, clinical predictors and relationship with in-hospital mortality

Giancarlo Marenzi, Nicola Cosentino, Andrea Marinetti, Antonio Maria Leone, Valentina Milazzo, Mara Rubino, Monica De Metrio, Angelo Cabiati, Jeness Campodonico, Marco Moltrasio, Silvio Bertoli, Milena Cecere, Susanna Mosca, Ivana Marana, Marco Grazi, Gianfranco Lauri, Alice Bonomi, Fabrizio Veglia, Antonio L. Bartorelli

Research output: Contribution to journalArticle

Abstract

Objectives We evaluated the rate of use, clinical predictors, and in-hospital outcome of renal replacement therapy (RRT) in acute myocardial infarction (AMI) patients. Methods All consecutive AMI patients admitted to the Coronary Care Unit between January 1st, 2005 and December 31st, 2015 were identified through a search of our prospectively collected clinical database. Patients were grouped according to whether they required RRT or not. Results Two-thousand-eight-hundred-thirty-nine AMI patients were included. Eighty-three (3%) AMI patients underwent RRT. Variables confirmed at cross validation analysis to be associated with RRT were: admission creatinine > 1.5 mg/dl (OR 16.9, 95% CI 10.4–27.3), cardiogenic shock (OR 23.0, 95% CI 14.4–36.8), atrial fibrillation (OR 8.6, 95% CI 5.5–13.4), mechanical ventilation (OR 22.6, 95% CI 14.2–36.0), diabetes mellitus (OR 4.8, 95% CI 3.1–7.4), and left ventricular ejection fraction < 40% (OR 9.1, 95% CI 5.6–14.7). The AUC for RRT with the combination of these predictors was 0.96 (95% CI 0.94–0.97; P < 0.001). In-hospital mortality was significantly higher in RRT patients (41% vs. 2.1%, P < 0.001). Oligoanuria as indication for RRT (OR 5.1, 95% CI 1.7–15.4), atrial fibrillation (OR 4.3, 95% CI 1.6–11.5), mechanical ventilation (OR 20.8, 95% CI 6.1–70.4), and cardiogenic shock (OR 12.9, 95% CI 4.4–38.3) independently predicted mortality in RRT-treated patients. The AUC for in-hospital mortality prediction with the combination of these variables was 0.92 (95% CI 0.87–0.98; P < 0.001). Conclusions Patients with AMI undergoing RRT had strikingly high in-hospital mortality. Use of RRT and its associated mortality were accurately predicted by easily obtainable clinical variables.

Original languageEnglish
Pages (from-to)255-261
Number of pages7
JournalInternational Journal of Cardiology
Volume230
DOIs
Publication statusPublished - Mar 1 2017

Keywords

  • Acute kidney injury
  • Acute myocardial infarction
  • In-hospital mortality
  • Renal replacement therapy

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

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    Marenzi, G., Cosentino, N., Marinetti, A., Leone, A. M., Milazzo, V., Rubino, M., De Metrio, M., Cabiati, A., Campodonico, J., Moltrasio, M., Bertoli, S., Cecere, M., Mosca, S., Marana, I., Grazi, M., Lauri, G., Bonomi, A., Veglia, F., & Bartorelli, A. L. (2017). Renal replacement therapy in patients with acute myocardial infarction: Rate of use, clinical predictors and relationship with in-hospital mortality. International Journal of Cardiology, 230, 255-261. https://doi.org/10.1016/j.ijcard.2016.12.130