Time Is Kidney: Relation between Pain-to-Balloon Time and Acute Kidney Injury among ST Segment Elevation Patients Undergoing Primary Percutaneous Intervention

Abstract

Background: Among ST segment elevation myocardial infarction (STEMI) early hemodynamic changes may result in acute kidney injury (AKI) even prior to primary percutaneous coronary intervention (PCI), however, no information to date is present regarding the association between pain to balloon (PBT) and AKI. We evaluated whether PBT predicts the risk of AKI among STEMI patients undergoing primary PCI. Methods: Medical records of 2343 STEMI patients undergoing primary PCI were reviewed. Patients were stratified by PBT into 3 groups: ≤120, 121-360 and > 360 minutes. Patients' records were assessed for the occurrence of AKI (defined by the KDIGO criteria as serum creatinine elevation ≥ 0.3 mg/dl within 72 hours after admission). Results: Mean age was 61 ± 13 years and 1919 (82%) were male. Patients having longer PBT had more AKI complicating the course of STEMI (7 % vs. 8 % vs. 13 %, p<0.001) and had significantly higher serum creatinine changes throughout hospitalization (0.08 mg/dl vs. 0.11 mg/dl vs.0.17 mg/dl p<0.001). In a multivariable logistic regression model each 1-hour increase in PBT was independently associated with a 2.2% increase in risk for AKI (OR 1.022, 95% CI 1.01-1.04, p=0.02). Conclusion: Longer PBT may be an independent marker for the development of AKI in STEMI patients undergoing primary.

Repeated Glutathione Sodium Salt Infusion May Counteract Contrast-Associated Acute Kidney Injury Occurrence in ST-Elevation Myocardial Infarction Patients Undergoing Primary PCI: A Randomized Subgroup Analysis of the GSH 2014 Trial

“…This made it possible to limit the bias related to confounders, giving more value to the result. Only increased door-to-balloon time was found to be positively correlated (OR1.61) with the development of CA-AKI, although this result was expected according to the recent literature [ 25 ]. Furthermore, we believe that the administration of GSS, not only as a single dose but also repeated over the three days following the pPCI, was of value in counteracting the oxidative burst, which may be prolonged [ 17 ].…”