ACUTE KIDNEY INJURI OF PATIENTS WITH ACUTE MIOCARD INFARCTION

Abstract

Aim of research – the comparative analysis of the frequency and the identification of factors for the development of acute kidney injury (AKI) in patients with myocardial infarction (MI) with and without the formation of pathologic Q-tooth. Material and methods. The total of 134 patients were studied and divided into 2 groups: Group 1 – patients with coronary heart disease (CHD) MI with pathologic Q tooth formation (n = 29); Group 2 – CHD MI patients without Q tooth formation (n = 105). Inclusion criteria are first-ever MI, age older than 18 years, increase in serum creatinine level above 26.5 μmol/l within 48 hours and decrease in diuresis less than 0,5 ml/ kg/h, informed voluntary consent for participation in the study. Exclusion criteria are terminal chronic renal failure, age under 18 years, chronic heart failure with left ventricular ejection fraction (LVEF) below 40%, MI anamnesis, refusal to participate in the study. Results. Among 134 patients with MI, signs of AKI were detected in 40 (29,9%) patients. In group 1, the mean value of glomerular filtration rate (GFR) was 41,0 ± 8,2, in group 2 it was 73,2 ± 13,9 ml/min/1,73m2. Signs of AKI in group 1 were observed in 20 (69,0%) patients, in group 2 in 20 (19,0%) patients. The comparative analysis of the study groups revealed that group 1 patients, compared to group 2 patients, had higher body mass index (BMI)(p < 0,001), more often concomitant chronic kidney disease (CKD) was observed (p < 0,001), lower hemoglobin level was typical (p < 0,001), and arterial hypotension was noted at prehospital stage (p = 0,034). In addition, group 1 patients were more likely to develop complications such as bleeding at the site of arterial puncture during percutaneous coronary intervention (PCI) (p < 0,046), pulmonary edema (p < 0,001) and cardiogenic shock (CS) (p < 0,001). The length of stay of group 1 patients in the Intensive Therapy and Resuscitation Department was 11,5 ± 3,6 bed days, group 2 was 9,6 ± 3,9 bed days (p < 0,019), and 8 (27,6%) patients and 1 (1,1%) died, respectively (p < 0,001). Conclusion. Early signs of AKI were detected in 29,9% of patients with MI; this condition was more frequent in the group of patients with MI who had a formed pathologic Q wave (69%). High BMI (p = 0,02), increased blood levels of HDL (p < 0,006) and total cholesterol (p < 0,001), decreased blood hemoglobin (p = 0,001), arterial hypotension (p = 0,013) and initial CKD (p < 0,001) were the factors contributing to the development of AKI.