SPC365

Early vs late development of acute kidney injury and its prognostic relevance in ACS patients

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Sara Cristina da Silva Borges

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.6 Acute Coronary Syndromes - Clinical
Session Type: Posters
FP Number: ---
Authors: Sara Borges; José João Monteiro; Pedro Carvalho; Catarina Ribeiro Carvalho; Marta Catarina Bernardo; Catarina Ferreira; J.Ilídio Moreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif">Background: Acute kidney injury (AKI) in acute coronary syndrome (ACS) patients (pts) is a well-known marker of worse prognosis. &nbsp;However, it remains unclear how timing of AKI correlates with mortality and morbidity; </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif">Objective: &nbsp;Assess the timing of AKI and evaluate its prognostic impact.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif">Methods: &nbsp;Retrospective study of pts with ACS periodically included in our center registry between March/2013 and December/2018. &nbsp;AKI was defined as an increase in&nbsp;creatinine&nbsp;&ge;0.3&nbsp;mg/dl; The primary endpoints was all-cause mortality and a composite of cardiovascular (CV) death, nonfatal myocardial infarction/stroke and readmission (MACCE) in the follow-up. Pts were classified into 3 groups according to the occurrence and timing of AKI: no-AKI (NA), early-AKI (EA)(&lt;48h) and late-AKI (LA) (&gt;48&nbsp;h).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif">Results: &nbsp;We included 518 pts (67&plusmn;13 years; 73% males, 46% STEMI) of whom 17% developed AKI during hospitalizations &ndash; 47% (41pts) during the first 48h (EA) and 53% (47 pts) after that period (LA). &nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif">During a median follow-up of 35 months, 42(8%) patients died and 96 (19%) had MACCE. AKI was associated with mortality (HR 3.6: 95% CI 1.8-7, p&lt;0.001) and MACCE (HR 1.8: 95% CI 1.1-3.1, p&lt;0.03). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif">When divided into 3 groups, early AKI pts had higher risk of death (HR 5.6 95%CI 1,7-18.8, p= 0.005) &nbsp;or MACCE (HR 2.57 95% CI 1.4-4.7, p=0,002) when compared to LA or NA (Figure 1)</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif">Early AKI pts were older (74 vs 67&plusmn;12, p&lt;0.001), had more CV risk factors (Hypertension 90% vs 66%, p=.002; diabetes mellitus 50%vs29%, p=.004) and comorbidities, namely: Chronic kidney disease (CKD): 14% vs 1%, p&lt;.001; Cerebrovascular disease 18 vs 6%, p=.008). During hospitalization they had more heart failure (Killip Kimball (KK) class</span><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:#333333">&ge;II: 25% vs 13%, p=.010) </span></span></span></span><span style="font-family:&quot;Arial Narrow&quot;,sans-serif">and lower left ventricle ejection fraction ( 46% vs 51%, p&lt;0.001)</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif">In multivariate analysis, after adjusting for age, CKD, percutaneous intervention and KK classe, early AKI was an independent a predictor of death (HR 1.1 95%CI 1.0-1,1, p= 0.007);</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif">Conclusion: &nbsp;In this population of ACS pts, AKI is a frequent complication and the timing of its development has major prognostic implications, since AKI that develops in the first 48h (EA) is associated with worse outcomes. On the other hand outcomes in patients with late onset AKI resemble those who don&rsquo;t develop AKI.</span></span></span></p>