Influence of acute kidney injury and chronic kidney disease on 3-year clinical outcomes in patients with AMI treated by contemporary PCI and optimal medical therapy; insights from J-MINUET study

Abstract Background The influence of acute kidney injury (AKI) and chronic kidney disease (CKD) on long-term outcomes following AMI in the era of modern primary PCI with optimal-medical-therapy (OMT) is still in debate. Methods A total of 3,281 patients with acute myocardial infarction (AMI) were enrolled in the J-MINUET registry with primary PCI of 93.1% in STEMI Consecutive patients hospitalized within 48 h of onset of AMI at 28 Japanese medical institutions were enrolled in the J-MINUET study (UMIN000010037). AKI was defined as an increase in serum-creatinine ≥0.3mg/dL or ≥50% within-48h during-hospitalization. CKD was defined as estimated glomerular filtration-rate [eGFR]<60mL/min/1.73m2. Major adverse cardiac event (MACE) was defined as a composite of all-cause death, cardiac-failure, MI and stroke. Patients were divided into 4 groups based on the presence or absence of CKD and the occurrence or non-occurrence of AKI. The parameters were assessed by the Cox proportional hazards model. Differences were considered statistically significant at P<0.05. Results Of the 3,281 patients with AMI, 3220 patients had complete data set. The average age was 69±13 years old and 75.3% of the patients were male. Of the 3220 patients, 1375 patients had CKD (42.7%) and AKI occurred in 365 patients (11.3%) during the initial hospital stay. AKI more frequently occurred in 305 CKD patients (22.2%) than 60 non-CKD patients (3.3%) (p<0.0001). A total of 898 MACE occurred (27.4%) during follow-up period (median of 768days). Kaplan-Meier curves illustrated event-free survival for MACE over 3 years stratified by the 4 groups (Figure). Conclusions While both CKD without AKI and non-CKD with AKI showed similar effect on the incidence of MACE, the worst clinical outcome was observed in patients having AKI on pre-existed CKD.