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Abstract: PO2545

AKI and Outcomes Following an Acute Myocardial Infarction

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • McGrath, Martina M., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Barkoudah, Ebrahim, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Claggett, Brian, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Jering, Karola, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Lewis, Eldrin F., Stanford University, Stanford, California, United States
  • Tokmakova, Mariya, Medicinski universitet-Plovdiv, Plovdiv, Plovdiv , Bulgaria
  • Van Der Meer, Peter, Rijksuniversiteit Groningen, Groningen, Groningen, Netherlands
  • Zhou, Yinong, Novartis Pharmaceuticals Corp, East Hanover, New Jersey, United States
  • Pfeffer, Marc A., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background

Development of acute kidney injury (AKI) is a poor prognostic factor among patients with coronary artery disease. We evaluated the frequency of AKI and its association with adverse kidney and cardiovascular (CV) outcomes in patients with an acute myocardial infarction (AMI) in the PARADISE-MI trial.

Methods

In this randomized, double-blind, active controlled, event-driven trial, 5,661 patients with AMI were assigned to receive sacubitril/valsartan or ramipril, with no run-in. Key exclusions were baseline eGFR <30mL/min/1.73m2, pre-existing heart failure (HF), and clinical instability. AKI was defined as an increase in serum creatinine ≥0.3mg/dL from baseline to day 7. Multivariable Cox regression models were fit to examine the association of AKI with the kidney composite (persistent ≥50% reduction in eGFR relative to baseline, end-stage renal disease, or renal death) and CV composite outcome (CV death, first HF hospitalization, or outpatient HF).

Results

AKI occurred in 275 (5.3%) of 5,207 patients with available data, over a median follow up of 1.8 years. Patients with AKI were more likely to be older, Asian, have higher SBP, diabetes, prior stroke, atrial fibrillation, STEMI without reperfusion in 24 hours, pulmonary congestion, higher Killip class, to be taking diuretics and have lower baseline eGFR (66 vs 72 mL/min/1.73m2), compared to those without AKI. AKI was more frequent among those taking sacubitril/valsartan than ramipril (6.0 vs 4.6%). AKI was associated with a higher adjusted risk of the kidney composite outcome (HR 8.4; 95% CI 3.9 to 17.9), which occurred in 37 (0.7%) of the 5,207 participants. There was no evidence for effect modification by randomized treatment (P-interaction=0.71). AKI was not significantly associated with the CV composite (HR 1.23; 95% CI 0.90 to 1.68), which occurred in 585 (11.2%) of 5,207 participants.

Conclusion

In patients with AMI, AKI is associated with higher risk of the composite kidney outcome, which occurred in only 0.7% of individuals, and did not differ according to randomized treatment.

Funding

  • Commercial Support – Novartis