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Acute Kidney Injury in Acute Coronary Syndrome

Marina Pieri, Alessandro Belletti, Fabrizio Monaco, Antonio Pisano, Mario Musu, Veronica Dalessandro, Giacomo Monti, Gabriele Finco, Alberto Zangrillo, Giovanni Landoni
BACKGROUND: In patients undergoing cardiac surgery, a reduced preoperative left ventricular ejection fraction (LVEF) is common and is associated with a worse outcome. Available outcome data for these patients address specific surgical procedures, mainly coronary artery bypass graft (CABG). Aim of our study was to investigate perioperative outcome of surgery on patients with low pre-operative LVEF undergoing a broad range of cardiac surgical procedures. METHODS: Data from patients with pre-operative LVEF ≤40 % undergoing cardiac surgery at a university hospital were reviewed and analyzed...
October 18, 2016: BMC Anesthesiology
Paul Whelton
BACKGROUND: Choice of the optimal target for blood pressure (BP) reduction during treatment of patients with hypertension, including those with underlying co-morbid conditions, is an important challenge in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) was designed to provide guidance in selection of a Systolic BP target during treatment of hypertension. METHODS: Adults ≥50 years old with hypertension and at least one additional risk factor for cardiovascular disease (CVD), but excluding persons with diabetes mellitus, prior stroke, or advanced chronic kidney disease (CKD) were randomly assigned to intensive therapy (intensive), targeting a systolic BP (SBP) <120 mmHg, or standard therapy (standard), targeting a SBP <140 mmHg...
September 2016: Journal of Hypertension
Ehimwenma J Ogbemudia, John Asekhame
OBJECTIVES: To determine the burden of preventable rehospitalization for decompensated heart failure in the elderly.  METHODS: This was a retrospective study performed in a Nigerian University Teaching Hospital,.   Demographic variables, etiology, and participants of heart failure were retrieved from data of elderly patients with heart failure admitted between January 2014 and December 2015. The participants were classified and described as either preventable, or unpreventable to determine whether the hospitalizations were preventable or not...
October 2016: Saudi Medical Journal
Paul Whelton
BACKGROUND: Choice of the optimal target for blood pressure (BP) reduction during treatment of patients with hypertension, including those with underlying co-morbid conditions, is an important challenge in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) was designed to provide guidance in selection of a Systolic BP target during treatment of hypertension. METHODS: Adults ≥50 years old with hypertension and at least one additional risk factor for cardiovascular disease (CVD), but excluding persons with diabetes mellitus, prior stroke, or advanced chronic kidney disease (CKD) were randomly assigned to intensive therapy (intensive), targeting a systolic BP (SBP) <120 mmHg, or standard therapy (standard), targeting a SBP <140 mmHg...
September 2016: Journal of Hypertension
Wassef Karrowni, Amit Navin Vora, David Dai, Daniel Wojdyla, Habib Dakik, Sunil V Rao
BACKGROUND: Acute kidney injury (AKI) complicating percutaneous coronary intervention (PCI) is associated with adverse clinical outcomes. To date, no studies have evaluated the association of blood transfusion with AKI in patients undergoing PCI. METHODS AND RESULTS: We used a retrospective cohort study of all patients with acute coronary syndrome undergoing PCI from CathPCI Registry (n=1 756 864). The primary outcome was AKI defined as the rise in serum creatinine post procedure ≥0...
September 2016: Circulation. Cardiovascular Interventions
Nicolas Meneveau, Geraud Souteyrand, Pascal Motreff, Christophe Caussin, Nicolas Amabile, Patrick Ohlmann, Olivier Morel, Yoann Lefrançois, Vincent Descotes-Genon, Johanne Silvain, Nassim Braik, Romain Chopard, Marion Chatot, Fiona Ecarnot, Hélène Tauzin, Eric Van Belle, Loïc Belle, François Schiele
BACKGROUND: No randomized study has investigated the value of optical coherence tomography (OCT) in optimizing the results of percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndromes. METHODS: We conducted a multicenter, randomized study involving 240 patients with non-ST-segment elevation acute coronary syndromes to compare OCT-guided PCI (use of OCT pre- and post-PCI; OCT-guided group) to fluoroscopy-guided PCI (angiography-guided group)...
September 27, 2016: Circulation
Nir Flint, Natalia Kaufman, Amir Gal-Oz, Gilad Margolis, Yan Topilsky, Gad Keren, Yacov Shacham
OBJECTIVE: Increased transmitral flow velocity (E) to the early mitral annulus velocity (e') ratio (E/e'), signifying increased cardiac filling pressure, was previously found to be associated with deterioration of renal function in patients with congestive heart failure. No study, however, included patients with acute myocardial ischemia. We hypothesized that elevated E/e' ratio would be associated with an increased risk of acute kidney injury (AKI) in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI)...
August 22, 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Axel Åkerblom, Robert M Clare, Yuliya Lokhnygina, Lars Wallentin, Claes Held, Frans Van de Werf, David J Moliterno, Uptal D Patel, Sergio Leonardi, Paul W Armstrong, Robert A Harrington, Harvey D White, Philip E Aylward, Kenneth W Mahaffey, Pierluigi Tricoci
BACKGROUND: Albuminuria is associated with cardiovascular (CV) outcomes. We evaluated albuminuria, alone and in combination with estimated glomerular filtration rate (eGFR), as a predictor of mortality and CV morbidity in 12,944 patients with non-ST-segment elevation acute coronary syndromes. METHODS: Baseline serum creatinine and urinary dipsticks were obtained, with albuminuria stratified into no/trace albuminuria, microalbuminuria (≥30 but <300 mg/dL), or macroalbuminuria (≥300 mg/dL)...
August 2016: American Heart Journal
Wuhua Jiang, Jie Teng, Jiarui Xu, Bo Shen, Yimei Wang, Yi Fang, Zhouping Zou, Jifu Jin, Yamin Zhuang, Lan Liu, Zhe Luo, Chunsheng Wang, Xiaoqiang Ding
BACKGROUND: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication with a poor prognosis. In order to identify modifiable perioperative risk factors for AKI, which existing risk scores are insufficient to predict, a dynamic clinical risk score to allow clinicians to estimate the risk of CSA-AKI from preoperative to early postoperative periods is needed. METHODS AND RESULTS: A total of 7233 cardiac surgery patients in our institution from January 2010 to April 2013 were enrolled prospectively and distributed into 2 cohorts...
2016: Journal of the American Heart Association
Mahdia Buargub, Zohra Omar Elmokhtar
Acute kidney injury (AKI) is associated with adverse short-and long-term outcomes. The aim of this study was to evaluate the incidence of AKI and the short-term mortality in patients admitted with acute coronary syndrome (ACS) to a single coronary care unit (CCU) in Tripoli, Libya. We retrospectively studied the medical records of ACS patients admitted to the CCU of a referral cardiology center, during the period from January 1, 2014, to December 31, 2014. AKI was defined according to the AKI network criteria...
July 2016: Saudi Journal of Kidney Diseases and Transplantation
David Neves, Adriana Belo, Ana Filipa Damásio, João Carvalho, Ana Rita Santos, Bruno Piçarra, José Aguiar
INTRODUCTION: Acute kidney injury (AKI) is a pathological phenomenon with a negative impact on outcomes in different clinical scenarios. Its mechanism in acute coronary syndrome (ACS) is not completely understood, and measures to prevent it are not uniform. We set out to study the incidence, clinical relevance, predictors and possible implications for patient management of AKI in ACS. METHODS: Using data from a multicenter national registry on ACS, we retrospectively analyzed predictors of AKI and its impact on outcomes (in-hospital complications and one-year mortality)...
July 2016: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Luca Di Lullo, Antonio Bellasi, Vincenzo Barbera, Mario Cozzolino, Domenico Russo, Antonio De Pascalis, Francesca Santoboni, Annalisa Villani, Silvia De Rosa, Marco Colafelice, Luigi Russo, Claudio Ronco
Cardiovascular disease and major cardiovascular events represent main cause of death in both acute and chronic kidney disease patients. Kidney and heart failure are common and frequently co-exist This organ-organ interaction, also called organ cross-talk, leads to well-known definition of cardiorenal syndrome (CRS). Here we will describe cardiovascular involvement in patients with acute kidney injury (AKI). Also known as Type-3 CRS or acute reno-cardiac CRS, it occurs when AKI contributes and/or precipitates development of acute cardiac injury...
May 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Jeff D Williamson, Mark A Supiano, William B Applegate, Dan R Berlowitz, Ruth C Campbell, Glenn M Chertow, Larry J Fine, William E Haley, Amret T Hawfield, Joachim H Ix, Dalane W Kitzman, John B Kostis, Marie A Krousel-Wood, Lenore J Launer, Suzanne Oparil, Carlos J Rodriguez, Christianne L Roumie, Ronald I Shorr, Kaycee M Sink, Virginia G Wadley, Paul K Whelton, Jeffrey Whittle, Nancy F Woolard, Jackson T Wright, Nicholas M Pajewski
IMPORTANCE: The appropriate treatment target for systolic blood pressure (SBP) in older patients with hypertension remains uncertain. OBJECTIVE: To evaluate the effects of intensive (<120 mm Hg) compared with standard (<140 mm Hg) SBP targets in persons aged 75 years or older with hypertension but without diabetes. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, randomized clinical trial of patients aged 75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT)...
June 28, 2016: JAMA: the Journal of the American Medical Association
Wim Vandenberghe, Sofie Gevaert, John A Kellum, Sean M Bagshaw, Harlinde Peperstraete, Ingrid Herck, Johan Decruyenaere, Eric A J Hoste
BACKGROUND: We evaluated the epidemiology and outcome of acute kidney injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and after cardiac surgery (CS). SUMMARY: We performed a systematic review and meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO), worsening renal failure (WRF) and renal replacement therapy (RRT). We investigated the three most common clinical causes of CRS-1: AHF, ACS and CS...
February 2016: Cardiorenal Medicine
Jiří Widimský
BACKGROUND: The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain. METHODS: We randomly assigned 9 361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes...
January 2016: Vnitr̆ní Lékar̆ství
Razi Khan, Malek Al-Hawwas, Raja Hatem, Lorenzo Azzalini, Annik Fortier, E Marc Joliecoeur, Jean-Francois Tanguay, Philippe Lavoie-L'Allier, Hung Q Ly
OBJECTIVES: This study sought to assess the impact of residual coronary artery disease (CAD), using the residual SYNTAX score (rSS), on in-hospital outcomes after primary percutaneous intervention (PPCI). The study also aimed to determine independent predictors for high rSS. Residual CAD has been associated with worsened prognosis in patients undergoing PCI for non-ST acute coronary syndromes. The rSS is a systematic angiographic score that measures the extent and complexity of residual CAD after PCI...
February 1, 2016: Catheterization and Cardiovascular Interventions
Nevin C Baker, Ricardo O Escarcega, Michael J Lipinski, Marco A Magalhaes, Edward Koifman, Sarkis Kiramijyan, Smita I Negi, Rebecca Torguson, Ron Waksman
OBJECTIVE: We evaluate the prevalence of complications and failure rates between the most commonly used "active" anchoring vascular closure device (VCD), AngioSeal™ and the "passive" anchoring VCD, Mynx™, in all-comers undergoing percutaneous coronary intervention (PCI). METHODS: A total of 4,074 patients between 2008 and 2014, representing an era when both devices were available, were included. Thirty-two percent were acute coronary syndromes (37% STEMI). VCD choice was at the operator's discretion and included AngioSeal (n = 2,910) or Mynx (1,164)...
February 2016: Journal of Interventional Cardiology
Josephine Warren, Roxana Mehran, Usman Baber, Ke Xu, Daniele Giacoppo, Bernard J Gersh, Giulio Guagliumi, Bernhard Witzenbichler, E Magnus Ohman, Stuart J Pocock, Gregg W Stone
BACKGROUND: Acute kidney injury (AKI) is a well-recognized predictor of morbidity and mortality after percutaneous coronary intervention. However, the impact of AKI on the outcome of patients with acute coronary syndromes (ACS) in relation to coronary artery bypass grafting (CABG) has not been established. METHODS: Of the 17,421 patients who presented with non-ST-segment elevation ACS or ST-segment elevation myocardial infarction enrolled in the ACUITY and HORIZONS-AMI trials, 1,406 (8...
January 2016: American Heart Journal
Shih-Hsien Sung, Chen-Huan Chen
Heart failure has become a major health problem worldwide with a substantial financial burden mainly from hospitalization due to acute heart failure syndrome (AHFS). A considerable number of patients hospitalized for the treatment of AHFS experience significant worsening of renal function, which is now recognized as type 1 cardiorenal syndrome (CRS) and is associated with worse outcomes. Currently known risk factors for acute CRS in AHFS include obesity, cachexia, hypertension, diabetes, proteinuria, uremic solute retention, anemia, and repeated subclinical acute kidney injury events...
October 2013: Pulse (Basel, Switzerland)
Tomas A Axelsson, Ari Mennander, Markus Malmberg, Jarmo Gunn, Anders Jeppsson, Tomas Gudbjartsson
OBJECTIVES: According to the EuroSCORE-II criteria, patients undergoing emergency coronary artery bypass grafting (CABG) are operated on before the beginning of the next working day after decision to operate while salvage CABG patients require cardiopulmonary resuscitation en route to the operating theatre. The objective of this multicentre study was to investigate the efficacy of emergency and salvage CABG. METHODS: A retrospective analysis of all patients that underwent emergency or salvage CAGB at four North-European university hospitals from 2006 to 2014...
May 2016: European Journal of Cardio-thoracic Surgery
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