Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction with Acute Kidney injury caused by Cardiogenic Shock, Is it Really Safe?; A Case Report

Oktafin Srywati Pamuna, Mohammad Saifur Rohman, Setyasih Anjarwani, Cholid Tri Tjahjono

Abstract


Background

ST-elevation myocardial infarction (STEMI) is a life-threatening condition. Timely treatment with Percutaneous Coronary Intervention (PCI) is a recommended management of STEMI. However, in STEMI condition accompanied by complications such as prolonged shock condition and become  Acute Kidney Injury (AKI), it is still a question of whether to be treated conservatively or invasively. If PPCI was an option, how to prevent the worsening outcome is still an issue

Case Illustration

A 53 years old, woman, was referred from a private hospital with STEMI inferior Killip IV onset 5 hours with typical chest pain and azotemia with creatinine serum was 3.4 mg/dl; eGFR 15 ml/m/1.73m2. In the emergency room, she got hydration, inotropic, and planned for PPCI.  After the PPCI procedure, she was fallen into the altered mental status and then referred to our hospital. The GCS was E4V4M6; blood pressure was 118/62 mmHg (on dobutamine 10 mcg/kg BW/minutes and NE 0.3 mcg/kg BW/minutes), heart rate was 130 bpm, respiration rate was 20 times per minute, peripheral saturation was 98% on NRBM 10 liters per minute. The laboratorium result in our hospital showed a creatinine level was 1.6 mg/dl. We treated this patient for 9 days, with optimal medicamentosa and fluid therapy. There is an improvement in clinical presentation and physical examination on the last day of treatment, with urine output 1900 cc/24 hours, creatinin serum 0.8 mg/dl, and eGFR  84 ml/min/1.73m2.

Conclusion

Acute renal failure is a frequent complication in STEMI, leading to higher mortality, morbidity, and intrahospital complications. PPCI is a reperfusion strategy recommended by the guideline in the setting of myocardial infarction with cardiogenic shock. Proper management to prevent worsening of renal function in this condition is very important.    

Keyword: acute kidney injury, cardiogenic shock, ST-elevation myocardial infarction


Keywords


acute kidney injury, cardiogenic shock, ST-elevation myocardial infarction

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References


Granger, CB. Delays in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients Presenting With Cardiogenic Shock. 2018;11(18).

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39(2):119–77.

Danilo E, Laville M, Covic A, Fouque D, Vanholder R, Juillard L, et al. NDT Perspectives A European Renal Best Practice ( ERBP ) position statement on the Kidney Disease Improving Global Outcomes ( KDIGO ) Clinical Practice Guidelines on Acute Kidney Injury : Part 1 : definitions, conservative management and contrast-induc. 2012;1–10.

Vavalle JP, Diepen S Van, Ms. RMC, Hochman JS, Weaver WD, Mehta RH, et al. NU SC. Am Heart J [Internet]. 2015; Available from http://dx.doi.org/10.1016/j.ahj.2015.12.001

Reinstadler SJ, Kronbichler A, Reindl M, Feistritzer HJ, Innerhofer V, Mayr A, et al. Acute kidney injury is associated with microvascular myocardial damage following myocardial infarction. Kidney Int [Internet]. 2017;92(3):743–50. Available from: http://dx.doi.org/10.1016/j.kint.2017.02.016

Kanic V, Vollrath M, Kompara G, Suran D, Hojs R. Women and acute kidney injury in myocardial infarction. J Nephrol [Internet]. 2018;31(5):713–9. Available from: http://dx.doi.org/10.1007/s40620-018-0504-4

El-Ahmadi A, Abassi MS, Andersson HB, Engstrøm T, Clemmensen P, Helqvist S, et al. Acute kidney injury – A frequent and serious complication after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. PLoS One. 2019;14(12):1–11.

Kooiman J, Seth M, Nallamothu BK, Heung M, Humes D, Gurm HS. Association Between Acute Kidney Injury and In-Hospital Mortality in Patients Undergoing Percutaneous Coronary Interventions. 2015;1–8.

Sinkovič A, Masnik K, Mihevc M. Predictors of acute kidney injury (AKI) in high-risk st-elevation myocardial infarction (STEMI) patients: A single-center retrospective observational study. Bosn J Basic Med Sci. 2019;19(1):101–8.

Basile DP, Anderson MD, Sutton TA. Pathophysiology of acute kidney injury. Compr Physiol. 2012;2(2):1303–53.

Häner JD, Räber L. Oral post-hydration after primary PCI for STEMI. Ann Transl Med. 2019;7(18):425–425.

Fan PC, Chen TH, Lee CC, Tsai TY, Chen YC, Chang CH. ADVANCES score predicts acute kidney injury after percutaneous coronary intervention for the acute coronary syndrome. Int J Med Sci. 2018;15(5):528–35.

Rihal CS, Textor SC, Grill DE, Berger PB, Ting HH, Best PJ, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002;105(19):2259–64.

Sood MM, Zieroth S. Acute Kidney Injury Following Percutaneous Coronary Intervention: Trying to Get Whole Eggs From an Omelette. Can J Cardiol [Internet]. 2015;31(10):1221–2. Available from: http://dx.doi.org/10.1016/j.cjca.2015.06.022

Dai X, Bumgarner J, Spangler A, Meredith D, Smith SC, Stouffer GA. Acute ST-elevation myocardial infarction in patients hospitalized for noncardiac conditions. J Am Heart Assoc. 2013;2(2):1–6.

Maioli M, Toso A, Leoncini M, Micheletti C, Bellandi F. Effects of hydration in contrast-induced acute kidney injury after primary angioplasty: A randomized, controlled trial. Circ Cardiovasc Interv. 2011;4(5):456–62.

Kanic V, Kompara G, Šuran D, Tapajner A, Naji FH, Sinkovic A. Acute kidney injury in patients with myocardial infarction undergoing percutaneous coronary intervention using radial versus femoral access. BMC Nephrol. 2019;20(1):1–7.

Tarvasmäki T, Haapio M, Mebazaa A, Sionis A, Silva-cardoso J, Tolppanen H, et al. Acute kidney injury in cardiogenic shock : definitions , incidence , haemodynamic alterations , and mortality. :572–81.




DOI: https://doi.org/10.21776/ub.hsj.2021.002.03.8

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