E.Yu. Brankovskaya, L.V. Kartun, E.V. Hodosovskaya, N.P. Mitkovskaya
The aim of the study was to investigate specific clinical manifestations, homeostasis indices and parameters of the cardiovascular system in patients with acute ST-elevation myocardial infarction (STEMI) and acute ischemic kidney injury. Methods. 173 patients with STEMI participated in the study. The study group consisted of 111 patients with acute ischemic kidney injury associated with myocardial infarction (MI); 62 patients with MI and normal kidney function were enrolled in the comparison group. Clinical, anthropometric, laboratory, and instrumental diagnostic methods were used. Results. Compared with patients of the MI and normal kidney function group, those with MI and acute ischemic kidney injury had a higher average heart rate, required more prolonged vasopressor and/or inotropic therapy, and more frequently developed tachyarrhythmias with adverse prognostic impact and postinfarction aneurysms. The study revealed that patients of the MI and acute ischemic kidney injury group demonstrated more severe dilatation of the left ventricle (LV), more pronounced reduction in myocardial LV contractility according to echocardiography results; they developed multivessel coronary artery disease more frequently. Furthermore, patients of this group had a higher incidence of infarction-associated artery damage located in the proximal segments of major coronary arteries and more frequently developed thrombotic occlusion in the infarction-affected artery. Patients with MI and acute ischemic kidney injury had higher levels of inflammatory, myocardial necrosis, hemostasis and neurohormonal activation markers. Higher concentration of neutrophil gelatinase-associated lipocalin (uNGAL) was observed in patients with MI and acute ischemic kidney injury; moreover, in 14,1% of patients belonging to this group, elevated levels of this marker preceded the diagnostically significant increase in creatinine concentration and decrease in glomerular filtration rate.
keywords: myocardial infarction, acute kidney injury

for references: Brankovskaya E.Yu., Kartun L.V., Hodosovskaya E.V., Mitkovskaya N.P. ST-elevation myocardial infarction and acute ischemic kidney injury Neotlozhnaya kardiologiya i kardioovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2020, vol. 4, no. 2, pp. 979–985

1. Kristensen S. D., Laut K. G, Fajadet J., Kaifoszova Z., Kala P., Di Mario C., Wijns W., Clemmensen P., Agladze V., Antoniades L., Alhabib K. F., De Boer M. J., Claeys M. J., Deleanu D., Dudek D., Erglis A., Gilard M., Goktekin O., Guagliumi G., Gudnason T., Hansen K. W., Huber K., James S., Janota T., Jennings S., Kajander O., Kanakakis J., Karamfiloff K. K., Kedev S., Kornowski R., Ludman P. F., Merkely B., Milicic D., Najafov R.,Nicolini F. A., Noc M., Ostojic M., Pereira H., Radovanovic D., Sabate M., Sobhy M., Sokolov M., Studencan M., Terzic I., Wahler S., Widimsky P., European Association for Percutaneous Cardiovascular Interventions. Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries. Eur Heart J, 2014, vol. 35, no. 29, pp. 1957-1970.
2. Sun Y.B., Tao Y., Yang M. Assessing the influence of acute kidney injury on the mortality in patients with acute myocardial infarction: a clinical trail. Ren Fail, 2018, vol. 40, no. 1, pp. 75-84. doi: 10.1080/0886022X.2017.1419969.
3. Rodríguez-Jiménez A.E., Negrín-Valdés T., Cruz-Inerarity H., Machural-de la Torre P.J. Cardiorenal syndrome as predictor of in-hospital mortality in ST-segment elevation myocardial infarction. Clin Investig Arterioscler, 2018, vol. 30, no. 4, pp. 163-169. doi: 10.1016/j.arteri.2017.12.005.
4. Amin A.P., Salisbury A.C., McCullough P.A., Gosch K., Spertus J.A., Venkitachalam L., Stolker J.M., Parikh C.R., Masoudi F.A., Jones P.G., Kosiborod M. Trends in the incidence of acute kidney injury in patients hospitalized with acute myocardial infarction. Arch Intern Med, 2012, vol. 172, pp. 246-253.
5. Wang C., Pei Y.Y.., Ma Y.H., Ma X.L., Liu Z.W., Zhu J.H., Li C.S. Risk factors for acute kidney injury in patients with acute myocardial infarction. Chin Med J (Engl), 2019, vol. 132, no. 14, pp. 1660-1665. doi: 10.1097/CM9.0000000000000293.
6. Al Suwaidi J., Reddan D.N., Williams K., Pieper K.S., Harrington R.A., Califf R.M., Granger C.B., Ohman E.M., Holmes DR Jr.; GUSTO-IIb, GUSTO-III, PURSUIT. Global Use of Strategies to Open Occluded Coronary Arteries. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy; PARAGON-A Investigators. Platelet IIb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in a Global Organization Network. Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation, 2002, vol.106, pp. 974-980. doi: 10.1161/01.cir.0000027560.41358.b3.
7. Khwaja A. KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Nephron Clin Pract, 2012, vol. 120, no 4, pp. 179-184. doi: doi: 10.1159/000339789.
8. Goldstein R.E., Haigney M.C. Heart-rate reduction and beta-blockade in early post-infarction cardiac remodelling. Cardiovasc Res, 2008, vol.79, no. 1, pp. 5-6. doi: 10.1093/cvr/cvn109.
9. Dobre D., Kjekshus J., Rossignol P., Girerd N., Benetos A., Dickstein K., Zannad F. Heart rate, pulse pressure and mortality in patients with myocardial infarction complicated by heart failure. Int J Cardiol, 2018, vol. 271, pp. 181-185. doi: 10.1016/j. ijcard.2018.05.017.
10. Mit’kovskaya N.P. Kardiogennyi shok pri ostrom infarkte miokarda – poteri i dostizheniya [Cardiogenic shock in acute myocardial infarction – losses and achievements]. Neotlozhnaya kardiologiya i kardioovaskulyarnye riski, 2017, vol. 1, no. 1, pp. 6-20. (in Russian).
11. Antunes P.E., Silva R., Ferrão de Oliveira J. Left ventricular aneurysms: early and long-term results of two types of repair. Eur J Cardiothorac Surg, 2005, vol. 27, pp. 210-215.
12. Jung M.H., Youn H.J., Jung H.O. The Influence of Apical Aneurysm on Left Ventricular Geometry and Clinical Outcomes: 3-Year Follow-Up Using Echocardiography. Echocardiography, 2016, vol. 33, no. 6, pp. 814-820. doi: 10.1111/echo.13188.
13. Antunes M.J., Antunes P.E. Left-ventricular aneurysms: from disease to repair. Expert Rev Cardiovasc Ther, 2005, vol. 3, no. 2, pp. 285-294.
14. Kyz'mina N.M. Vliyanie porazheniya stvola levoy koronarnoy arterii na sokratitel'nyu fynkziyu levogo zhelydochka v otdalennom periode [Influence of the main left coronary artery disease on the left ventricular contractile function in the long term period] Vestnik Avizenny, 2011, no. 1, pp. 50-52. (in Russian).
15. Westman P. C., Lipinski M. J., Luger D., Waksman R., Bonow R. O., Wu E., Epstein S. E. Inflammation as a Driver of Adverse Left Ventricular Remodeling After Acute Myocardial Infarction. J Am Coll Cardiol, 2016, vol. 67, no. 17, pp. 2050-2060. doi: 10.1016/j.jacc.2016.01.073.
16. Razi M.M., Abdali N., Asif S.M., Azharuddin M.M. Association of inflammatory cytokines/biomarkers with acute coronary syndrome and its correlation with severit y and hospital outcome. J Clin Prevent Cardiol, 2017, vol. 6, no. 2, pp. 44-49.
17. Siasos G., Lazaros G., Oikonomou E., Zografos T., Antonopoulos A., Papaioannou S., Latsios G., Vavuranakis M., Stefanadis C., Tousoulis D. The prognostic role of C-reactive protein after myocardial infarction in patients with normal or mildly impaired left ventricle systolic function. Int J Cardiol, 2016, vol. 220, pp. 173-175. doi: 10.1016/j.ijcard.2016.06.135.
18. Tang Y., Mak S. K., Xu A. P., Lan H. Y. Role of C-reactive protein in the pathogenesis of acute kidney injury. Nephrology (Carlton), 2018, vol. 4, pp. 50-52. doi: 10.1111/nep.13454.
19. Clerico A., Passino C. Predictive Value of NT-proBNP in Patients with Acute Myocardial Infarction. Clin Chem,. 2017, vol. 63, no. 5, pp. 1045-1046. doi: 10.1373/clinchem.2016.269522.
20. Delcayre C., Silvestre J.S., Garnier A., Oubenaissa A., Cailmail S., Tatara E., Swynghedauw B., Robert V. Cardiac aldosterone production and ventricular remodeling. Kidney Int, 2000, vol. 57, no. 4, pp. 1346-1351.
21. Gulov M.K., Rafiev H.K., Abdulloev S.M. Epidemiologiya, factory riska I diagnostika hronicheskoy pochechnoy nedostatochnosti [Epidemiology, risk factors, and diagnosis of chronic renal failure] Vestnik Avizenny, 2018, vol. 20, no. 2-3, pp. 190-196. (in Russian).
22. Haase M., Devarajan P., Haase-Fielitz A., Bellomo R., Cruz D.N., Wagener G., Krawczeski C.D., Koyner J.L., Murray P., Zappitelli M., Goldstein S.L., Makris K., Ronco C., Martensson J., Martling C.R., Venge P., Siew E., Ware L.B., Ikizler T.A., Mertens P.R. The Outcome of Neutrophil Gelatinase-Associated Lipocalin (NGAL)-positive Subclinical Acute Kidney Injury: A Multicenter Pooled Analysis of Prospective Studies. J Am Coll Cardiol, 2011, vol. 57, no 17, pp. 1752-1761.
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