Baseline eGFR cutoff for increased risk of post-contrast acute kidney injury in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction in the emergency department

Abstract

Acute myocardial infarction is an acute-stage disease that requires prompt diagnosis and treatment. Primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) is a high-risk factor for post-contrast acute kidney injury (PC-AKI). This retrospective cohort study analyzed the data of 754 patients with STEMI who underwent pPCI and were integrated into the Fast Interrogation Rule for STEMI critical pathway program between 2015 and 2019. We aimed to determine the optimal cutoff baseline eGFR for identifying a high risk of PC-AKI after multivariable adjustment with statistically significant risk factors. We also compared the incidence rates of PC-AKI between the previous and current diagnostic criteria. The probability of PC-AKI increased when the baseline estimated glomerular filtration rate (eGFR) was ≤ 79mL/min/1.73 m2. The optimal cutoff baseline eGFR for high risk of PC-AKI was found to be an eGFR of ≤ 61 mL/min/1.73 m2 after multivariable adjustment. The current diagnostic criteria more accurately identified the patient group with impaired renal function. Our results have clinically significant implications for identifying patients at a high risk of developing PC-AKI, especially before and after the use of contrast agents in patients who require PCI for STEMI in the emergency department.

Fig 1. Flow diagram of enrolled patients.

FIRST, Fast Interrogation Rule for ST-elevation MI; MI, myocardial infarction; DNAR, Do Not Attempt Resuscitation; PCI, percutaneous coronary intervention; PC-AKI, post contrast- acute kidney injury.

Fig 2

A. Receiver operating characteristic (ROC) curve showing the probability of PC-AKI. Cut-off point for eGFR ≤ 79mL/min/1.73 m². AUC (area under the curve) = 0.866 (0.789,0.925). B. ROC curve was drawn for PC-AKI prediction probabilities using significant variables from the multivariable analysis. Cut-off point for eGFR ≤ 61mL/min/1.73 m². AUC = 0.951 (0.924,0.979). PC-AKI, post-contrast acute kidney injury; eGFR, estimated glomerular filtration rate.