Thrombolysis and acute kidney injury in patients with myocardial infarction

The aim of the study was examination of the incidence and severity of the acute kidney injury (AKI) in patients with acute myocardial infarction with ST-elevation (STEMI) after thrombolytic therapy with alteplase or streptokinase. Methods. 292 patients (227 men and 65 women, mean age 58 ± 11 years) with STEMI were studied. All patients received thrombolytic therapy: 170 received streptokinase, and 122 - alteplase. Coronary angiography in acute stage of myocardial infarction was exclusion criteria. AKI was defined according to KDIGO Guidelines. Results. Thrombolysis was effective in 213 (73%) patients. There was no statistically significant difference in effectiveness of thrombolysis in the groups of patients who received streptokinase or alteplase (÷2 = 1,14; p = 0,28). Seventy-two (25%) patients developed AKI: 60 (35%) received streptokinase and 12 (10%) - alteplase (÷2 = 15,75; p = 0,0001). The severity of AKI was higher in patients treated streptokinase than alteplase (÷2 = 14,93; p = 0,0001). The incidence of arterial hypotension as complication of fibrynolythic administration was higher in the group of patients who received streptokinase (÷2 = 9,38; p = 0,002). The in-hospital mortality (6%) was significantly associated with AKI. Conclusions. Our results show that the incidence of AKI in patients with STEMI is 25%. The incidence and severity of AKI was higher in patients treated with streptokinase than those treated with alteplase. AKI was significantly associated with in-hospital mortality.

острый инфаркт миокарда с подъемом сегмента ST, острое повреждение почек, стрептокиназа, альтеплаза, артериальная гипотония, ST-segment elevation acute myocardial infarction, acute kidney injury, streptokinase, alteplase, arterial hypotension

1. Национальные рекомендации по диагностике и лечению больных острым инфарктом миокарда с подъемом сегмента ST ЭКГ // Кардиоваскулярная терапия и профилактика. 2007. Т. 6. № 8. Приложение 1. С. 415-500.

2. Мензоров М.В., Шутов А.М., Серов В.А. и др. Острое повреждение почек у больных инфарктом миокарда и эффективность тромболитической терапии // Кардиология. 2012. № 5. С. 8-12.

3. Мензоров М.В., Шутов А.М., Серов В.А. и др. Острое повреждение почек у больных инфарктом миокарда с подъемом сегмента ST // Нефрология. 2012. № 1. С. 40-44.

4. Серов В.А., Шутов А.М. Прогностическое значение хронической болезни почек у больных хронической сердечной недостаточностью // Нефрология и диализ. 2008. № 3-4. С. 214-218.

5. Явелов И.С. Клинические аспекты тромболитической терапии при остром инфаркте миокарда // Фарматека. 2003. № 6. С. 14-24.

6. Berns A.S. Nephrotoxicity of contrast media // Kidney Int. 1989. № 36. P. 730-740.

7. Bolognese L., Falsini G., Schwenke C. et al. Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the Contrast Media and Nephrotoxicity Following Primary Angioplasty for Acute Myocardial Infarction [CONTRAST-AMI] Trial) // Am. J. Cardiol. 2012. Vol. 109. № 1. P. 67-74.

8. Chua H.R., Glassford N., Bellomo R. Acute kidney injury after cardiac arrest // Resuscitation. 2012. Vol. 83. № 6. P. 721-727.

9. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation // European Heart Journal. 2012. № 33. P. 2569-2619.

10. Fliser D., Laville M., Covic A. et al. 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-induced nephropathy // Nephrol. Dial. Transplant. 2012. Vol. 27. № 12. P. 4263-4272.

11. Fox C.S., Muntner P., Chen A.Y. et al. Short-term outcomes of acute myocardial infarction in patients with acute kidney injury: a report from the national cardiovascular data registry // Circulation. 2012. Vol. 125. № 3. P. 497-504.

12. Goldberg A., Hammerman H., Petcherski S. et al. In-hospital and 1-year mortality of patients who develop worsening renal function following acute ST-elevation myocardial infarction // Am. Heart J. 2005. Vol. 150. P. 330-337.

13. Hou S.H., Bushinsky D.A., Wish J.B. et al. Hospital-acquired renal insufficiency: a prospective study // Am. J. Med. 1983. Vol. 74. P. 243-248.

14. KDIGO Clinical Practice Guidelines for Acute Kidney Injury // Kidney International Supplements. 2012. № 2. P. 5-138.

15. Kim M.J., Choi H.S., Oh S.H. et al. Impact of acute kidney injury on clinical outcomes after ST elevation acute myocardial infarction // Yonsei Med. J. 2011. Vol. 52. № 4. P. 603-609.

16. Linnik W., Tintinalli J.E., Ramos R. Associated reactions during and immediately after rtPA infusion // Ann. Emerg. Med. 1989. Vol. 18. № 3. P. 234-239.

17. Marenzi G., Assanelli E., Campodonico J. et al. Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission // Crit. Care Med. 2010. Vol. 38. № 2. P. 438-444.

18. Mehta R.L., Kellum J.A., Shah S. et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury // Crit. Care 2007. № 11. P. 31.

19. Nash K., Hafeez A., Hou S. Hospital-acquired renal insufficiency // Am. J. Kidney Dis. 2002. Vol. 39. P. 930-936.

20. O’Gara P.T., Kushner F.G., Ascheim D.D. et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of ST elevation myocardial infarction: a report of the American College of cardiology Foundation / American Heart Association Task Force on practice guidelines // Circulation. 2013. Vol. 127. P. e362-e425.

21. Parikh C.R., Coca S.G., Wang Y. et al. Long-term Prognosis of Acute Kidney Injury After Acute Myocardial Infarction // Arch. Intern. Med. 2008. Vol. 168. P. 987-995.

22. Ronco C., Haapio M., House A.A. et al. Cardiorenal syndrome // J. Am. Coll. Cardiol. 2008. Vol. 52. P. 1527-1539.

23. Rudnick M.R., Goldfarb S., Tumlin J. Contrast-induced nephropathy: is the picture any clearer? // Clin. J. Am. Soc. Nephrol. 2008. № 3. P. 261-262.

24. Shema L., Ore L., Geron R. et al. Contrast-induced nephropathy among Israelihospitalized patients: incidence, risk factors, length of stay and mortality // Isr. Med. Assoc. J. 2009. Vol. 11. № 8. P. 460-464.

25. Tatu-Chit,oiu G., Teodorescu C., Dan M. et al. Streptokinase-induced hypotension has no detrimental effect on patients with thrombolytic treatment for acute myocardial infarction. A substudy of the Romanian Study for Accelerated Streptokinase in Acute Myocardial Infarction (ASK-ROMANIA) // Rom. J. Intern. Med. 2004. Vol. 42. № 3. P. 557-573.

26. Torres S., Albuquerque A., Gomes L. et al. Arterial blood pressure behavior during the administration of intravenous streptokinase, in patients with acute myocardial infarction // Rev. Port. Cardiol. 2001. Vol. 20. Suppl 5. P. 147-152.

27. The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction // N. Engl. J. Med. 1993. Vol. 329. P. 673-682.