Prediction of Acute Kidney Injury among ST- Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Intervention by Hemoglobin Level and Left Ventricular Function

Abstract
Background: Among patients with ST-segment Elevation Myocardial Infarction (STEMI) undergoing primary Percuta-neous Coronary Intervention (PCI), worsening of renal function resulting in Acute Kidney Injury (AKI) is a frequent compli-cation known to be associated with adverse outcomes. Also, anemia on admission is associated with an increased risk for (AKI). The relation between echocardiographic parameters of Left Ventricular (LV) function and the risk of AKI among patients with STEMI undergoing PCI is still controversial.
Aim of the Study: Detection of the relationship between hemoglobin level and LV systolic and diastolic function as a predictors for developing AKI after primary PCI in patients with STEMI.
Methods: A prospective observational cohort study con-ducted from June 2016 to June 2017, at Cardiovascular Medicine Department, Tanta University Hospitals in Gharbia Governorate, Egypt. The study enrolled 38 consecutive adult patients of both genders who were diagnosed with definite STEMI within 12 hours from the time of symptoms onset and were treated by PCI who developed AKI after the procedure. The study population (38 patients) was then subdivided according to severity of renal impairment according to creat-inine clearance (Cr cl ) into two groups:
Group I: Those who developed severe renal impairment with Cr.cl £30ml/min (17 patients).
Group II: Those who developed mild to moderate renal impairment with Cr.cl ³30ml/min (21 patients).
They were subjected to full clinical examination, labora-tory investigation including serum creatinine (sCr) level that was determined on hospital admission, before primary PCI, and at least once a day during the cardiac Intensive Care Unit stay, complete blood count with special attention to Hemo-globin (Hb) level at hospital admission before primary PCI. All patients underwent a screening echocardiography within three days of admission, measurement of LV systolic function was performed using the commercially available machine (Vivid 7, GE Medical System, Horten, Norway) with a 3.5- MHz transducer. LV systolic function was assessed using M-mode in parasternal long axis view.
Results: Group I patients were older (70.65±10.36 years vs 57.43±12.09 years, p=0.001), but there was no statistacillay significant difference between both groups for risk factors, smoking, dyslipidemia, diabetes, time to reperfusion, addiction, site of infarction or Killip's classification; but there was more prevelance of prior MI in Group I than Group II. There was a statistically significant difference between both groups as regard Hb level (10.65±0.996gm/dl vs 11.62±1.396gm/dl, p= 0.017), EF (40.18±7.40% vs 48.67±8.05%, p=0.002), Cr cl ( 26.35±2.18ml/min vs 39. 10±5.61ml/min, p=0.001), sCr on admission (1.36±0.21ml/dl vs 1.06±0.20ml/dl, p=0.001), peak sCr (2.08±0.32ml/dl vs 1.79±0.32ml/dl, p=0.010) and s.Cr level at discharge (1.55±0.21ml/dl vs 1.36±0.18ml/dl, p= 0.004).
Conclusion: Older ages, previous history of myocardial infarction, TIMI flow after PCI, anemia on admission, level of serum creatinine on admission, creatinine clearance and impaired systolic function of left ventricle were strongly statistically different with developing AKI and related to its severity, while no significant statistical difference could be found as regard gender, smoking, addiction, diabetes, dyslip-idemia, Killip classification, time to reperfusion, or site of infarction with incidence of developing AKI.