Incidence and mortality of acute kidney injury in acute myocardial infarction patients: a comparison between AKIN and RIFLE criteria

Abstract

AKIN criteria are more sensitive in defining AKI compared with the RIFLE criteria in STEMI. However, no difference exists in the mortality risk provided by these two scoring systems.

Acute Kidney Injury Definition and In‐Hospital Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention for ST‐Segment Elevation Myocardial Infarction

“…To date, several AKI definitions based on absolute and/or relative sCr increase have been shown to be useful in predicting clinical outcome in STEMI; however, no study prospectively compared them in terms of prognostic accuracy. To our knowledge, only 2 studies investigated the incidence and associated mortality of 2 AKI definitions in patients with STEMI undergoing pPCI . Nonetheless, the Risk, Injury, Failure, Loss, and End‐stage kidney disease (RIFLE) classification was 1 of the 2 definitions used in both studies.…”

“…RIFLE takes into account a ≥50% increase in sCr, a criterion that has been investigated less extensively in this specific clinical setting . Moreover, because of a retrospective design, a small patient population, and lack of mortality discrimination assessment, no definite conclusion can be drawn about which AKI definition should be preferred for mortality risk prediction in STEMI patients.…”

“…Third, we considered only the AKI definitions that are used most frequently, thus we cannot exclude the possibility that different absolute and/or relative thresholds of sCr value may better assess mortality in these patients. Fourth, we evaluated in‐hospital outcomes only; however, previous studies assessing the long‐term outcomes of STEMI patients found that the greatest mortality difference between those with and without AKI was observed during hospitalization. This was shown to be true even when the criterion of 0.5 mg/dL sCr increase was considered .…”

“…P atients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) are at high risk of acute kidney injury (AKI), a complication that is associated with a striking increase in mortality. [1][2][3][4][5][6][7][8][9] The AKI definitions that are most widely used are relative (≥25%) and absolute (≥0.5 mg/dL) increases in serum creatinine (sCr) concentration occurring in the first 48 to 72 hours after hospital admission. 10,11 Moreover, a lower threshold of absolute sCr increase (≥0.3 mg/dL) was proposed recently to define AKI in patients with both cardiovascular and noncardiovascular diseases.…”

“…10,11 Moreover, a lower threshold of absolute sCr increase (≥0.3 mg/dL) was proposed recently to define AKI in patients with both cardiovascular and noncardiovascular diseases. 12,13 Although these definitions were shown to be closely associated with increased in-hospital mortality in STEMI patients undergoing pPCI, [1][2][3][4][5][6][7][8][9][10] no study has prospectively compared them in terms of prognostic accuracy in a large cohort of patients; therefore, it is still unclear which definition may provide the best risk prognostication for STEMI patients. Notably, the relationship between sCr and glomerular filtration rate (GFR) is not linear.…”