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Acute kidney injury, the worst nightmare in patients with myocardial infarction and cardiogenic shock
Session:
SESSÃO DE POSTERS 07 - DOENÇAS CARDIOVASCULARES - LESÃO RENAL AGUDA E INFLAMAÇÃO
Speaker:
Marta Paralta De Figueiredo
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type:
Cartazes
FP Number:
---
Authors:
Marta Paralta De Figueiredo; Rafael Viana; Miguel Carias; António Rocha de Almeida; Rita Louro; Orlando Luquengo; Bruno Piçarra; Manuel Trinca
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background: </strong>Cardiogenic shock (CS) in patients with acute coronary syndromes (ACS) is one of the most challenging situations in a cardiac intensive care unit due to the high complexity and mortality associated. There are several cardiac and non-cardiac factors that could impact the mortality rate in this group – identifying them can be an important advantage in the outcome of ACS with CS.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>This study aims to determine predictors of mortality in patients admitted with ACS complicated with CS.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>We retrospectively analysed patients admitted with ACS to our institution over a 7-year period and selected those who presented with CS. We recorded demographic data, personal history, heart rate (HR), blood pressure, ECG data, existence of mechanical complications and laboratory data. Multivariate regression analysis was performed to identify predictors of in-hospital mortality and eliminate cofounders. An increase in creatinine of 0.3mg/dL and >50% compared to baseline value was defined as AKI.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>We documented 419 patients with ACS who evolved in CS. They were predominantly male (63.2%) with a mean age of 72<span style="font-family:Symbol">±</span>13 years. Regarding personal history, 71.8% had arterial hypertension, 56.0% had dyslipidemia, 33.8% diabetes mellitus and 22.0% were smokers. In this population, we documented 39,6% (n=166) of in-hospital mortality. Multivariate linear regression revealed a statistically significant association between mortality and AKI <span style="font-family:Symbol">[b</span>=1.339; OR 3.82 (CI: 2.39-6.10); p<0.001)<span style="font-family:Symbol">]</span> and the existence of mechanical complications <span style="font-family:Symbol">[b</span>=1.143; OR 3.14 (CI 1.40-7.04); p=0.006<span style="font-family:Symbol">]</span>. Other associations that were statistically significant, but with <span style="font-family:Symbol">b</span><1.0 were age <span style="font-family:Symbol">³</span>75 years-old (p=0.001), HR<span style="font-family:Symbol">³</span>100bpm (p=0.021) and Hb at admission <12.0mg/dL (p=0.020). AKI was revealed as the strongest predictor of in-hospital mortality in ACS with CS. There were no other statistically significant variables associated with mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>There are multiple factors that impact mortality rates in patients with ACS that progresses to CS, however the presence of acute kidney injury was the strongest independent predictor. Therefore, a swift recognition and approach of AKI may benefit the outcome of patients with ACS complicated with CS.</span></span></p>
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