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Lin KY, Shang XL, Guo YS, Zhu PL, Wu ZY, Jiang H, Ruan JM, Zheng WP, You ZB, Lin CJ. Association of Preprocedural Hyperglycemia With Contrast-Induced Acute Kidney Injury and Poor Outcomes After Emergency Percutaneous Coronary Intervention. Angiology 2018; 69:770-778. [PMID: 29463106 DOI: 10.1177/0003319718758140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We investigated whether preprocedural hyperglycemia was associated with contrast-induced acute kidney injury (CI-AKI) and long-term outcomes in patients with acute coronary syndrome (ACS) who underwent emergency percutaneous coronary intervention (PCI). Patients (n = 558) with ACS who underwent emergency PCI were consecutively enrolled. Preprocedural hyperglycemia was defined as glucose levels >198 mg/dL (11 mmol/L). The primary outcome was CI-AKI (≥0.3 mg/dL absolute or ≥50% relative serum creatinine increase 48 hours after contrast medium exposure). Overall, 103 (18.5%) patients had preprocedural hyperglycemia and 89 (15.9%) patients developed CI-AKI. The incidence of CI-AKI was significantly higher in patients with hyperglycemia than without (28.2% vs 13.2%; P < .01). Multivariate analysis indicated that preprocedural hyperglycemia was an independent predictor of CI-AKI (odds ratio = 1.971, 95% confidence interval [CI]: 1.129-3.441; P < .05). In addition, preprocedural hyperglycemia was associated with an increased risk of all-cause mortality during the 2-year follow-up (hazard ratio = 2.440, 95% CI: 1.394-4.273; P = .002). Preprocedural hyperglycemia is a significant and independent predictor of CI-AKI and long-term outcomes.
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Affiliation(s)
- Kai-Yang Lin
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China.,2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
| | - Xiu-Ling Shang
- 3 Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Yan-Song Guo
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China
| | - Peng-Li Zhu
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China
| | - Zhi-Yong Wu
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China
| | - Hui Jiang
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China
| | - Jing-Ming Ruan
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China.,2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
| | - Wei-Ping Zheng
- 2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
| | - Zhe-Bin You
- 2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
| | - Chun-Jin Lin
- 2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
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Reinstadler SJ, Kronbichler A, Reindl M, Feistritzer HJ, Innerhofer V, Mayr A, Klug G, Tiefenthaler M, Mayer G, Metzler B. Acute kidney injury is associated with microvascular myocardial damage following myocardial infarction. Kidney Int 2017; 92:743-750. [PMID: 28412022 DOI: 10.1016/j.kint.2017.02.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/13/2017] [Accepted: 02/16/2017] [Indexed: 11/28/2022]
Abstract
Acute kidney injury (AKI) is a frequent complication in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention. However, the pathophysiology of AKI in this setting is complex and goes beyond the administration of contrast media. Studies assessing the impact of infarct characteristics on AKI are currently lacking. Therefore, we investigated the association of AKI with myocardial as well as microvascular injury in an initial total of 361 consecutive STEMI patients treated by primary percutaneous coronary intervention. Of these, 318 patients were included in final analysis. Serum creatinine was measured on admission as well as 24, 48, and 72 hours thereafter with AKI defined as an increase in serum creatinine of 0.3 mg/dl or more. Cardiac magnetic resonance (CMR) scans were performed in the first week after infarction, with microvascular injury visualized by late gadolinium enhancement CMR defined as any region of hypoenhancement within the hyperenhanced area of infarction. Sixteen patients developed AKI. They showed significantly lower left ventricular ejection fraction (45[interquartile range 40-52]% vs. 54[47-59]%), larger infarct size (21[15-35]% vs. 12[7-22]%) of left ventricular myocardial mass, and more frequent microvascular injury (81 vs. 46%) than those free of AKI. Meaningfully, in multivariate analysis including all CMR data, microvascular injury was the sole independent predictor of AKI (odds ratio 6.74, 95% confidence interval of 1.49-30.43). Thus, among revascularized STEMI patients, the presence of microvascular injury assessed by CMR was independently associated with an increased risk of AKI. This suggests a potential pathophysiological link between cardiac microvascular disease and renal injury following STEMI.
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Affiliation(s)
- Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Andreas Kronbichler
- University Clinic of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Hans-Josef Feistritzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Veronika Innerhofer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Martin Tiefenthaler
- University Clinic of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Gert Mayer
- University Clinic of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse, Innsbruck, Austria.
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Laufer Perl M, Havakuk O, Finkelstein A, Halkin A, Revivo M, Elbaz M, Herz I, Keren G, Banai S, Arbel Y. High red blood cell distribution width is associated with the metabolic syndrome. Clin Hemorheol Microcirc 2017; 63:35-43. [PMID: 26444609 DOI: 10.3233/ch-151978] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES High values of Red Blood Cell Distribution Width (RDW) have been associated with adverse outcome in various clinical settings. The mechanism behind this association is not clear. The Metabolic Syndrome (MetS) is a chronic inflammatory disorder that increases the risk for cardiovascular disease and death. The aim of our study was to evaluate the association between high RDW and the MetS in a relatively large cohort of patients. METHODS A cohort of 3,529 consecutive patients undergoing coronary angiography was used to evaluate the association between RDW and the MetS. The association was assessed by using a logistic regression. Cox's regression analysis was used to evaluate the impact of RDW on long term mortality. RESULTS The mean age was 65 years (range 24-97), with 27% women. Overall, 30% were diagnosed with metabolic syndrome. The prevalence of MetS was 29% in patients with RDW <14% and 34% in patients with RDW ≥14% (P = 0.003).Using multivariate analysis, RDW values above 14% were independently associated with MetS (odds ratio 1.2 [95% CI 1.0-1.4], P = 0.043). Among all the criteria of the metabolic syndrome, hypertension, elevated glucose levels and abdominal obesity were associated with high RDW, with hypertension being the strongest criteria, with an increased risk of 1.8 fold ([95% CI 1.5-2.1]; P = 0.001). During follow up (1614 ± 709 days, 2-2763 days), long term mortality was 8% in the low RDW group and 28% in the high RDW group (p < 0.001). CONCLUSION RDW ≥14% is independently associated with higher rates of metabolic syndrome and long-term all-cause mortality.
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Affiliation(s)
- Michal Laufer Perl
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Havakuk
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Halkin
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miri Revivo
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meital Elbaz
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Herz
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Schulich Heart Centre, Sunnybrook Medical Centre, Toronto, Ontario, Canada
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Acute kidney injury among ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention: a multifactorial entity. J Nephrol 2016; 29:169-174. [PMID: 26861658 DOI: 10.1007/s40620-015-0255-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/27/2015] [Indexed: 12/16/2022]
Abstract
Acute kidney injury is a frequent complication among ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), and is associated with adverse outcomes. While contrast nephropathy is considered the most important reason for worsening of renal function, recent data have suggested the role of other important factors among this specific patient population. In the present review, we examine the various factors leading to renal impairment in STEMI patients and place the findings in the context of this specific patient population in the era of primary PCI. These factors include contrast nephropathy, time to coronary reperfusion, cardiac pump function and hemodynamics as well as various inflammatory and metabolic markers.
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Arbel Y, Havakuk O, Halkin A, Revivo M, Berliner S, Herz I, Weiss-Meilik A, Sagy Y, Keren G, Finkelstein A, Banai S. Relation of metabolic syndrome with long-term mortality in acute and stable coronary disease. Am J Cardiol 2015; 115:283-7. [PMID: 25499926 DOI: 10.1016/j.amjcard.2014.10.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/28/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
Past studies examining the effects of the metabolic syndrome (MS) on prognosis in postangiography patients were limited in size or were controversial in results. The aim of the study was to examine the association of the MS and the risk for long-term mortality in a large cohort of patients undergoing coronary angiography for various clinical indications. Medical history, physical examination, and laboratory values were used to diagnose patients with the MS. Cox regression models were used to analyze the effect of MS on long-term all-cause mortality. We prospectively recruited 3,525 consecutive patients with a mean age of 66 ± 22 years (range 24 to 97) and 72% men. Thirty percent of the cohort had MS. Patients with MS were more likely to have advanced coronary artery disease and acute coronary syndrome (p <0.001). Patients with MS had more abnormalities in their metabolic and inflammatory biomarkers regardless of their clinical presentation. A total of 495 deaths occurred during a mean follow-up period of 1,614 ± 709 days (median 1,780, interquartile range 1,030 to 2,178). MS was associated with an increased risk of death in the general cohort (hazard ratio [HR] 1.27, 95% confidence interval [CI] 1.01 to 1.56, p = 0.02). MS had a significant effect on mortality in stable patients (HR 1.55, 95% CI 1.1 to 2.18, p = 0.01), whereas it did not have a significant effect on mortality in patients with acute coronary syndrome (HR 1.11, 95% CI 0.86 to 1.44, p = 0.42). In conclusion, MS is associated with increased mortality in postangiography patients. Its adverse outcome is mainly seen in patients with stable angina.
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Red Blood Cell Distribution Width (RDW) and long-term survival in patients with ST Elevation Myocardial Infarction. Thromb Res 2014; 134:976-9. [DOI: 10.1016/j.thromres.2014.08.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/12/2014] [Accepted: 08/19/2014] [Indexed: 11/17/2022]
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Arbel Y, Shacham Y, Ziv-Baran T, Laufer Perl M, Finkelstein A, Halkin A, Revivo M, Milwidsky A, Berliner S, Herz I, Keren G, Banai S. Higher Neutrophil/Lymphocyte Ratio Is Related to Lower Ejection Fraction and Higher Long-term All-Cause Mortality in ST-Elevation Myocardial Infarction Patients. Can J Cardiol 2014; 30:1177-82. [DOI: 10.1016/j.cjca.2014.05.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/12/2014] [Accepted: 05/12/2014] [Indexed: 11/26/2022] Open
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