SPC365

Rethinking AKI Risk: Beyond Contrast Volume in Acute Myocardial Infarction

Session: SESSÃO DE POSTERS 07 - DOENÇAS CARDIOVASCULARES - LESÃO RENAL AGUDA E INFLAMAÇÃO
Speaker: Catarina Lagoas Pohle

Congress: CPC 2025
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Cartazes
FP Number: ---
Authors: Catarina Lagoas Pohle; Jéni Quintal; Rui Antunes Coelho; Patrícia Bernardes; David Campos; Marco Tomaz; Catarina Sá; Joana Silva Ferreira; Filipe Seixo
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">Introduction </span></span></strong><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">Acute kidney injury (AKI) is a frequent complication following acute myocardial infarction (AMI), influenced by multiple factors and associated to prolonged hospital stays and worse outcomes. While contrast volume used in coronary angiography is traditionally considered a key risk factor, its significance in contemporary clinical practice remains controversial. The purpose of this study was to assess predictive factors for AKI and to evaluate the prognostic value of the presence and grade of AKI in AMI patients.</span></span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">Methods: </span></span></strong><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">R</span></span><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">etrospective analysis including&nbsp;consecutive AMI patients admitted to a Cardiology Department from November 2021 to October 2022. <span style="color:black">Demographic characteristics, cardiovascular risk factors, serial creatinine levels (at admission, 24- and 48- hours post-coronary angiography), hs-TnI, NT-proBNP, and other laboratory parameters were collected. AKI presence and severity were classified using the AKIN criteria. L</span>ogistic regression models were employed to identify predictors of AKI.</span></span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">Results </span></span></strong><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">375 patients were included (72% male), of which 7.7% had previous history of chronic kidney disease (CKD). 10.7% of patients developed AKI (7.5% AKIN I, 1.9% AKIN II and 2.4% AKIN III). Patient characteristics are described in Table 1. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">Patients with CKD had 5.26 times higher odds of developing AKI (OR=5.26 [95% CI: 2.37-13.00]; p&lt;0.001). Patients on </span></span><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">angiotensin converting enzyme </span></span><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">inhibitors or </span></span><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">angiotensin receptor blockers</span></span><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;"> had higher odds of AKI (OR=2.10 [95% CI: 1.06-4.20]; p=0.03), as did those on insulin therapy (OR=3.04 [95% CI: 1.13-8.19]; p=0.04).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">Killip class was significantly associated with the presence of AKI (p&lt;0.001), with higher prevalence of AKI in Killip classes III and IV. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">Overall, mean contrast volume did not differ significantly between AKI and non-AKI groups. However, when analysing AKIN stages, we found contrast volume to be higher in patients with AKIN III (p=0.013). </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">Results of logistic regression are shown in table 2. On multivariate analysis, NTproBNP was the only independent predictor of AKI, remaining a strong predictor even when adjusted for the most relevant baseline clinical and laboratory parameters (Wald=14.093; p&lt;0.001). </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">Patients with AKI had higher in-hospital mortality (OR=6.673 [95% CI: 2.011 to 22.144]; p=0.005). </span></span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">Conclusions </span></span></strong><span style="font-size:10pt"><span style="font-family:&quot;Avenir Book&quot;">These findings suggest the need to focus on intrinsic patient factors rather than contrast volume alone when assessing AKI risk. In particular, NT-proBNP, as a surrogate for congestion, may be a good predictor of AKI after AMI. The fact that AKI was associated with increased in-hospital mortality underscores the need for targeted prevention and management strategies.</span></span></span></span></span></p>