SPC365

Acute kidney injury on admission for acute coronary syndrome as a predictor of 1-year mortality

Session: Posters (Sessão 5 - Écran 6) - DAC e Cuidados Intensivos 7 - Marcadores de Risco e Prognóstico
Speaker: Miguel Carias

Congress: CPC 2022
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Miguel Carias de Sousa; Bruno Piçarra; Ana Rita Santos; Rita Rocha; Mafalda Carrington; Francisco Cláudio; Kisa Congo; Manuel Trinca; em Nome Dos Investigadores do Registo Nacional de Síndromes Coronárias Agudas

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The approach of patients admitted for acute coronary syndrome (ACS) is a challenge due to the high complications that can occur. This can affect the prognosis in these patients. Acute kidney injury (AKI) is often observed by external damage or decreased peripheral perfusion conditioned by the patient&#39;s hemodynamic status.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To evaluate the AKI as a predictor of in-hospital and 1-year mortality in patients with ACS.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A 3-year retrospective study was performed, including patients from a National Multicenter Registry with ACS. A linear regression analysis and a Cox regression survival analysis were performed, with in-hospital mortality and 1-year mortality as endpoints respectively. The sample was divided into two groups: with and without AKI. An increase in creatinine of 0.3mg/dL and &gt;50% compared to baseline value was defined as AKI. The population was also characterized according to demographic data, cardiovascular risk factors (CVRF), days of hospitalization and in-hospital complications (reinfarction, major hemorrhage, stroke, heart failure, atrioventricular block, atrial fibrillation and sustained ventricular tachycardia). Thus, the mortality of patients with ACS with and without AKI was compared.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">5275 patients were enrolled and 294 met the mortality endpoints (5.6%). The population consisted of 72.4% of male elements and 27.6% of female elements, with an average age of 66<span style="font-family:Symbol">&plusmn;</span>13 years. Regarding CVRF, 70.0% had arterial hypertension, 60.0% dyslipidemia, 29.7% Diabetes mellitus and 27.8% were smokers. A Linear regression analysis revealed that elements with AKI had higher in-hospital mortality than those without <span style="font-family:Symbol">[b</span>=0.891; p=0.002; OR 2.437 (CI: 1.392-4.269)<span style="font-family:Symbol">]</span>. In addition, these elements had a greater number of major bleeding events during the inpatient regime (3.0% vs 1.1%; p&lt;0.001) and longer hospital stays (8.3 days vs 4.7 days; p&lt;0.001). The other associations were not statistically significant. According to a survival analysis using a Cox regression, elements with AKI had an in-hospital and 1-year mortality 1.813 times higher compared to those without AKI <span style="font-family:Symbol">[b</span>=0.595; p=0.001; HR 1.813 (CI: 1.262-2.605)<span style="font-family:Symbol">]</span>.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In ACS, the risk of in-hospital and 1-year death in patients with AKI is 81.3% higher compared to those without. Thus, we conclude that AKI entails a high-risk profile in patients with ACS, so its identification and approach is extremely important and could change the prognosis in these patients.</span></span></span></p>