Acute cardiorenal anemia syndrome among ST-elevation myocardial infarction patients treated by primary percutaneous intervention

Abstract

Background Acute kidney injury (AKI) and anemia have been extensively studied in ST-elevation myocardial infarction (STEMI), yet the precise nature of their reciprocal relationship has not been elucidated in STEMI patients. Methods We performed a retrospective analysis of 2096 consecutive patients admitted for STEMI between January 2008 and December 2018 and treated with primary coronary intervention. Patients were stratified into four groups according to the presence of baseline anemia and occurrence of AKI: without anemia or AKI, baseline anemia without AKI, AKI without baseline anemia and acute cardiorenal anemia syndrome (CRAS), defined as the occurrence of AKI in patients with baseline anemia. Patients’ medical records were reviewed for in-hospital complications, 30-day and long-term mortality. Results The mean age was 61 ± 13 years and 1682 patients (80%) were men. Ten percent of patients had baseline anemia without AKI, 7% had AKI without baseline anemia and 3% were classified as CRAS. We found increments between the four groups for occurrence of new onset atrial fibrillation and heart failure rates, presence of a critical state, and both 30-day and long-term mortality (P < 0.001 for all). Logistic regression models demonstrated that as compared to AKI alone, CRAS was associated with a higher risk for long-term mortality (HR 10.49; 95% CI 6.5–17.1) as compared to anemia (HR 3.32, 95% CI 2.1–5.2) and AKI (HR 7.71, 95% CI 5.1–11.7) alone (P < 0.001 for all). Conclusions Among STEMI patients, the interaction between anemia and AKI is associated with worse short and long-term outcomes and reflects the reciprocity of cardiac and renal exacerbations.

Myocardial Revascularization Strategies in ST Elevation Myocardial Infarction Without Urgent Revascularization: Insight From a Nationwide Study

“…In this nationwide study, timing of intervention demonstrates that when the 48 hours windows is outdated, revascularization, even percutaneous, is usually performed after few days (mean delay of 10 days for PCI). In addition to surgery timing (13), several other factors emerged in the literature as predictors for adverse outcomes in STEMI patients undergoing CABG such as age, female gender, preoperative cardiogenic shock or heart failure, CABG after failed PCI or fibrinolysis, and the degree of preoperative myocardial injury as quantified by cardiac troponin (10)(11)(12)(13)(14). In our cohort, we observed that in France patients who underwent CABG between 48 hours to 90 days were sicker than those who had PCI.…”

Timing of coronary artery bypass grafting in patients with myocardial infarction. Is the earlier the better?

“…Secondly, when discussing the timing of surgery after MI, it is more plausible to exclude patients with STEM who were operated within hours of the insult as the short and long term outcome of these patients is different from those who are operated after a few days. 13 Moreover, patients operated within or after 7 days of MI have the same mortality and hence surgery should not be delayed for such patients if other comorbidities allow. This is a retrospective study and has certain limitations.…”