High Kidney Function in Myocardial Infarction Patients Who Underwent Coronary Intervention: Acute Kidney Injury Risk and Long-term Prognosis

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Canadian Journal of Cardiology Pub Date : 2026-10-01 Epub Date: 2026-04-13 DOI:10.1016/j.cjca.2026.04.001

Shuo Wu MD, Shikun Wang MD, PhD, Feng Xu MD, PhD, Jiaojiao Pang MD, PhD, Yuguo Chen MD, PhD

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引用次数: 0

Abstract

Background

Acute kidney injury (AKI) is a critical complication in ST-segment elevation myocardial infarction (STEMI) patients who undergo percutaneous coronary intervention (PCI). The effect of high preoperative estimated glomerular filtration rate (eGFR; ≥ 105 mL/min/1.73 m²) on AKI and long-term adverse outcomes remains poorly understood.

Methods

In this multicentre, prospective cohort study we enrolled 4536 STEMI consecutive patients who underwent emergency PCI in China. Logistic regression was used to assess the association between preoperative eGFR and AKI, and Cox regression was used to evaluate the effect of preoperative eGFR and AKI on 2-year adverse outcomes.

Results

Among 4536 patients, 820 (18.1%) had high eGFR, 1806 (39.8%) normal eGFR (90-105 mL/min/1.73 m²), 1547 (34.1%) mild reduction of eGFR (60-90 mL/min/1.73 m²), and 363 (8.0%) had low eGFR (< 60 mL/min/1.73 m²). Mean age was 62 years; 23.2% were female. Low and high eGFR levels were independently associated with increased AKI risk (adjusted odds ratio, 1.818 [95% confidence interval (CI), 1.268-2.608] and 2.143 [95% CI, 1.517-3.025]). Two-year major adverse cardiovascular events incidence increased progressively with declining eGFR: 4.0% (high), 5.5% (normal), 11.3% (mild), and 22.3% (low). Among patients with normal-to-high eGFR, those with AKI had higher risks of major adverse cardiovascular events (hazard ratio, 2.418 [95% CI, 1.579-3.704]) and all-cause mortality (hazard ratio, 2.380 [95% CI, 1.407-4.025]).

Conclusions

This study confirmed a U-shaped relationship between preoperative eGFR and AKI, highlighting that high eGFR is an under-recognized risk factor for AKI and long-term adverse outcomes in STEMI patients. These findings underscore the need for enhanced clinical vigilance and tailored management strategies for PCI patients with high preoperative eGFR.

Clinical Trial Registration

NCT03510832.

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接受冠状动脉介入治疗的心肌梗死患者高肾功能：急性肾损伤风险和长期预后

背景：急性肾损伤（AKI）是st段抬高型心肌梗死（STEMI）患者接受经皮冠状动脉介入治疗（PCI）的重要并发症。术前估计的高肾小球滤过率（eGFR,≥105 mL/min/1.73 m2）对AKI和长期不良结局的影响尚不清楚。方法：这项多中心、前瞻性队列研究连续入组4536例在中国接受急诊PCI治疗的STEMI患者。Logistic回归评估术前eGFR和AKI之间的关系，Cox回归评估术前eGFR和AKI对2年不良结局的影响。结果：4536例患者中，820例（18.1%）eGFR高，1806例（39.8%）eGFR正常（90-105），1547例（34.1%）轻度降低（60-90），363例（8.0%）eGFR低(结论：本研究证实术前eGFR与AKI之间呈u型关系，强调高eGFR是STEMI患者AKI和长期不良结局的未被充分认识的危险因素。这些发现强调了对术前eGFR高的PCI患者提高临床警惕性和量身定制的管理策略的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian Journal of Cardiology 医学-心血管系统

CiteScore

9.20

自引率

8.10%

发文量

546

审稿时长

32 days

期刊介绍： The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.