SPC365

Prognostic impact of acute kidney injury in major bleeding in acute coronary syndrome patients

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Pedro Rocha Carvalho

Congress: CPC 2021
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: Posters
FP Number: ---
Authors: Pedro Rocha Carvalho; Sara Borges; José João Monteiro; Catarina Carvalho; Marta Bernardo; Joaquim Chemba; Paulo Fontes; Ilidio Moreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Acute kidney injury (AKI) is a well-known marker of adverse events in acute coronary syndrome (ACS) patients. It&#39;s role in predicting bleeding risk is not well established.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Methods:</span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black"> Retrospective study of ACS patients admitted to a single center, between October/2011 and September/2018. Patients on dialysis were excluded. </span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Serum creatinine at the admission and maximum value during hospitalization were recorded. <span style="color:black">KDIGO criteria were used for the definition of AKI (</span>Increase in SCr by &gt;0.3 mg/dl within 48 hours; or &gt; Increase in SCr to x1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or Urine volume 0.5 ml/kg/h for 6 hours<span style="color:black">). The primary endpoint was major bleeding during follow-up, using the International Society on Thrombosis and Haemostasis criteria. </span></span></span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black"><strong>Results:</strong> </span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">570 patients were included in the analysis - mean age 66.1 &plusmn; 13.1 years; 74,9% males; 42.6% STEMI (ST-Elevation Myocardial Infarction). During hospitalization 12,3% of patients had AKI. These patients had more comorbidities: arterial hypertension (80,5 vs 61,3%; p&lt;0.05) and arterial peripheral disease (8,6 VS 2,6% e P&lt;0,05), but similar bleeding history (3,9% vs 2,2%; p=0.366), prior ACS (13,9 vs 12, p=0,623), significant renal disease (glomerular filtration rate &lt; 45 ml/min) (17% Vs 12,7 p=0,332) and previous atrial fibrillation (7,1 vs 6,4%, p=0,838). At admission pts with AKI had lower Hg levels (p=0,047). Platelets levels, acute heart failure [Killip Class&gt;1 (18,1 Vs 14, p=0,346)], STEMI (50,7 vs 45,8, p=456), multi-vessel disease (MVD) and angioplasty was similar in both groups (59.3% vs 66.2%, p=0,1 for MVD and 67,5% vs 76,5%, p=0,1 for angioplasty). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">At discharge there were no differences in anthytrombotic therapy.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">During a median follow-up of 41 months (IQR: 20-59), 91 patients (15.8%) died and 62 (10.7%) had major bleeding. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Acute kidney injury was a predictor of major bleeding (HR 1.777 95% CI: 0,99-3,19; p=0,054) even after adjusting for anemia and arterial peripheral disease.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Conclusion:</span></span></span></strong> <span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Pts with ACS who develop AKI during hospitalization <span style="color:black">had higher risk of major bleeding. Thus this should be considered in the bleeding risk estimation as may impact on antithrombotic therapy.</span></span></span></span></span></p>