TY - JOUR
T1 - Renal replacement therapy in patients with acute myocardial infarction
T2 - Rate of use, clinical predictors and relationship with in-hospital mortality
AU - Marenzi, Giancarlo
AU - Cosentino, Nicola
AU - Marinetti, Andrea
AU - Leone, Antonio Maria
AU - Milazzo, Valentina
AU - Rubino, Mara
AU - De Metrio, Monica
AU - Cabiati, Angelo
AU - Campodonico, Jeness
AU - Moltrasio, Marco
AU - Bertoli, Silvio
AU - Cecere, Milena
AU - Mosca, Susanna
AU - Marana, Ivana
AU - Grazi, Marco
AU - Lauri, Gianfranco
AU - Bonomi, Alice
AU - Veglia, Fabrizio
AU - Bartorelli, Antonio L.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - 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.
AB - 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.
KW - Acute kidney injury
KW - Acute myocardial infarction
KW - In-hospital mortality
KW - Renal replacement therapy
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U2 - 10.1016/j.ijcard.2016.12.130
DO - 10.1016/j.ijcard.2016.12.130
M3 - Article
AN - SCOPUS:85009360516
VL - 230
SP - 255
EP - 261
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -