Determination of Predictors of Acute Kidney Injury in Patients with Coronary Bifurcation Lesions Revascularized with the Two-Stent Strategy

Introduction: Acute kidney injury (AKI) is an important complication that increases mortality, morbidity, hospitalization and costs after the invasive cardiac procedures. The incidence of AKI and the factors affecting the development of AKI after the revascularization of coronary bifurcation lesions with the two-stent strategy remain unclear. Patients and Methods: We retrospectively evaluated 230 consecutive non-ST elevation myocardial infarction (NSTEMI) patients who underwent revascularization with the two-stent strategy for the true coronary artery bifurcation lesions between January 2015 and September 2020, and did not meet the exclusion criteria. AKI was defined as meeting Acute Kidney Injury Network (AKIN) group criteria with the development of creatinine changes within the first 48 hours after the procedure. ACEF (age, serum creatinine, left ventricular ejection fraction) score was calculated for all patients. Results: AKI developed in 28 (12.2%) patients after the procedure. As a result of the multivariable analysis, hypertension, ACEF score ≥ 1.14 and contrast agent volume ≥ 252 mL were determined as independent predictors for AKI. The coronary anatomical factors and technique related factors had no effect on AKI development. ACEF score ≥ 1.14 had sensitivity of 82.1%, specificity of 60.9% and negative predictive value of 96.1% for detecting AKI development. Moreover, the rate of AKI in the group with high ACEF score was significantly higher than the group with low ACEF score (22.5% vs. 3.9%, p< 0.001). Conclusion: The simple and extremely user-friendly ACEF score can accurately describe the risk of AKI development after the revascularization of coronary bifurcation lesions with the two-stent strategy.