Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission

Crit Care Med. 2010 Feb;38(2):438-44. doi: 10.1097/CCM.0b013e3181b9eb3b.


Objective: To evaluate the clinical and prognostic relevance of acute kidney injury (AKI) in the setting of ST-elevation acute myocardial infarction (STEMI) complicated by cardiogenic shock (CS).

Design: Prospective study.

Setting: Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center.

Patients: Ninety-seven consecutive STEMI patients with CS at admission, undergoing intra-aortic balloon pump (IABP) support and primary percutaneous coronary intervention (PCI).

Interventions: None.

Measurements and main results: We measured serum creatinine at baseline and each day for the following 3 days. Acute kidney injury was defined as a rise in creatinine >25% from baseline. Overall, AKI occurred in 52 (55%) patients, and in 12 of these patients, a renal replacement therapy was required. In multivariate analysis, age >75 yrs (p = .005), left ventricular ejection fraction < or = 40% (p = .009), and use of mechanical ventilation (p = .01) were independent predictors of AKI. Patients developing AKI had a longer hospital stay, a more complicated clinical course, and significantly higher mortality rate (50% vs. 2.2%; p <.001) than patients without AKI. In our population, AKI was the strongest independent predictor of in-hospital mortality (relative risk 12.3, 95% confidence intervals 1.78 to 84.9; p <.001).

Conclusions: In patients with STEMI complicated by CS, AKI represents a frequent clinical complication associated with a poor prognosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / complications*
  • Acute Kidney Injury / mortality
  • Aged
  • Angioplasty, Balloon, Coronary
  • Creatinine / blood
  • Electrocardiography
  • Female
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Intra-Aortic Balloon Pumping
  • Logistic Models
  • Male
  • Myocardial Infarction / complications*
  • Myocardial Infarction / mortality
  • Prognosis
  • Prospective Studies
  • Renal Replacement Therapy
  • Risk
  • Shock, Cardiogenic / complications*
  • Shock, Cardiogenic / mortality
  • Treatment Outcome


  • Creatinine