Author + information
- Giancarlo Silvio Marenzi,
- Nicola Cosentino,
- Jeness Campodonico,
- Marco Moltrasio,
- Valentina Milazzo,
- Mara Rubino,
- Milena Cecere,
- Susanna Mosca,
- Monica De Metrio,
- Ivana Marana,
- Marco Grazi,
- Gianfranco Lauri and
- Antonio Bartorelli
Background: Patients with acute myocardial infarction (AMI) may require a renal replacement therapy (RRT) during their index event. Until now, data on RRT use in AMI patients is limited, as they have usually been pooled together with cohorts of critically ill patients. In this observational study we evaluated the incidence, clinical predictors, and in-hospital outcomes of AMI patients requiring RRT. Moreover, we investigated the clinical factors associated with in-hospital mortality in RRT-treated patients.
Methods: AMI patients, identified in a prospectively collected database, were grouped according to whether they required RRT or not.
Results: Of the 2,839 AMI patients, 83 (3%) underwent RRT (for acute fluid overload [81%], oligoanuria [66%], or both). The following variables were found to be associated with RRT use and were confirmed at cross validation analysis: admission creatinine >1.5 mg/dl (adjusted OR 8.8, 95% CI 5.0-15.6; P<0.001), cardiogenic shock (OR 5.1, 95% CI 2.4-10.8; P<0.001), atrial fibrillation (OR 4.9, 95% CI 2.8-8.5; P<0.001), mechanical ventilation (OR 4.6, 95% CI 2.3-9.3; P<0.001), diabetes (OR 3.6, 95% CI 2.0-76.3; P<0.001), and LVEF <40% (OR 2.9, 95% CI 1.6-5.3; P<0.001). At ROC analysis, the AUC for need of RRT obtained with the combination of these 6 predictors was 0.96 (95% CI 0.94-0.97; P<0.001). In-hospital mortality was higher in RRT patients than in those not requiring RRT (41% vs. 2%; P<0.001). The following variables were found to be independently associated with mortality in patients treated with RRT: oligo-anuria as indication for RRT (adjusted OR 15.9, 95% CI 2.3-109.2; P<0.001), atrial fibrillation (OR 12.2, 95% CI 2.0-73.2; P<0.001), mechanical ventilation (OR 9.9, 95% CI 2.1-47.8; P<0.001), and cardiogenic shock (OR 8.7, 95% CI 1.6-48.0; P<0.001). At ROC analysis, the AUC for in-hospital mortality prediction in RRT patients, obtained with the combination of these 4 predictors, was 0.92 (95% CI 0.87-0.98; P<0.001).
Conclusions: Patients with AMI undergoing RRT have strikingly high in-hospital mortality. Use of RRT, as well as its associated mortality can be accurately predicted by easily obtainable clinical variables.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Coronary Syndromes, Diagnosis, Management and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1253-334
- 2017 American College of Cardiology Foundation