Clinical and Angiographic Predictors of Acute Kidney Injury in ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Background Acute kidney injury (AKI) is a significant consequence of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). It is linked to greater mortality, longer hospital stays, and increased morbidity. Improving healthcare outcomes requires identifying individuals who are at high risk. Objective The aim of this study is to ascertain the prevalence, predictors, and immediate consequences of AKI in STEMI patients receiving initial PCI. Methodology From January 2023 to December 2024, 207 adult STEMI patients who received primary PCI at a tertiary cardiac center were included in this prospective observational study. Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define AKI. Angiographic, clinical, and baseline demographic data were documented. To find independent predictors of AKI, multivariate logistic regression analysis was employed, and discriminative power was evaluated using receiver operating characteristic (ROC) curves. Results AKI occurred in 56 patients (27.05%). Diabetes, hypertension, age, and gender did not significantly differ between the AKI and non-AKI groups. However, AKI patients experienced more clinical shock, anterior wall myocardial infarction, left anterior descending (LAD) lesions, a higher Killip class, and a substantially longer symptom-to-door time. Clinical shock, LAD lesion, contrast volume >145 ml, and Killip class III/IV were independent predictors of AKI. The highest ROC area under curve (AUC) was observed for Killip class III/IV (AUC=0.81). Conclusion Clinical shock, LAD involvement, a large contrast volume, and Killip class III/IV are significant predictive factors for AKI following PCI. Prevention requires early risk categorization and contrast-minimizing approaches.