DYNAMICS OF RENAL FUNCTIONAL STATUS AND PREDICTORS OF ACUTE KIDNEY INJURY DEVELOPMENT IN STEMI PATIENTS AFTER REVASCULARIZATION

The aim of the study is to assess the functional status of the kidneys in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent urgent revascularization within 3 days, and to identify independent predictors of acute kidney injury.Material and methods. A prospective, single-center study involving 286 STEMI patients with a mean age of 62.8±9.8 years, who were hospitalized within 12 hours of pain onset to Vinnytsia Regional Center for Cardiovascular Pathology. Among the examined patients, there were 202 men (70.6%) and 84 women (29.4%). Results. A decrease in creatinine levels of more than 10% from baseline on the 3rd day of observation was recorded in 93 patients (36.0%), who were distributed into Group I for further analysis. Group II consisted of 165 patients (64%) without negative creatinine dynamics. In Group I, there were significantly more men, 77.4% compared to 66.1%, p=0.06, which generally contradicts the existing data on the influence of female gender on renal functional status. Patients in Group I were younger than those in Group II; there were significantly more individuals with a BMI of 20-25 kg/m² in Group II (p=0.05). Among individuals in Group I, there was a statistically significant difference in the prevalence of type 2 diabetes, with 27 (29.0%) compared to 26 (15.8%), p=0.01, and atrial fibrillation (all forms), with 16 (17.2%) compared to 13 (7.9%), p=0.02.It was found that the level of troponin I was significantly higher in Group I, p=0.01. Additionally, interesting data were observed regarding the frequency of diagnosed cases of acute heart failure – Killip III and Killip IV – among patients in Group I, which were statistically significant compared to patients in Group II, p=0.002 and p=0.008, respectively. Highly informative (p<0.00001) independent predictors of acute kidney injury development in patients with ACS after PCI should include the glomerular filtration rate (GFR) calculated by CKD-EPI Cystatin C on the 1st day, the left atrial size in mm according to echocardiography data, and the hemoglobin level in g/L on day 1 (F=42.43, 34.20, and 32.39, respectively, compared to 32.31 for the model).Conclusions. Thus, a decrease in creatinine levels of more than 10% from baseline on the 3rd day of observation was recorded in 93 patients (36.0%). A decrease in creatinine levels was more frequently observed among younger men with normal baseline renal function. The decrease in creatinine levels was associated with acute heart failure Killip III-IV, atrial fibrillation, and type 2 diabetes.