The Association of Fractional Pulse Pressure with Acute Kidney Injury in Patients Undergoing Coronary Intervention Due to ST-Segment Elevated Myocardial Infarction.

OBJECTIVE: Acute kidney injury (AKI), which is prevalent in ST-segment elevated myocardial infarction (STEMI) patients undergone primary percutaneous coronary intervention (PCI), is associated with poor cardiovascular outcome. As high pulse pressure (PP) is associated with adverse cardiovascular events, the present study's aim was to evaluate the relationship between fractional PP (PPf) and AKI in patients with STEMI who underwent primary PCI. SUBJECT AND METHODS: All laboratory findings as well as echocardiographic and angiographic data of 1170 consecutive STEMI patients were retrospectively screened. PPf was calculated from the pressures invasively measured after sheath insertion and before performing coronary angiography. RESULTS: From 1170 eligible STEMI patients (mean age was 56, 18.2% of them were female), AKI developed in 143 (12.2%) patients. The PPf and pulsatility index were significantly higher in patients with AKI than those without (0.53 0.10 vs. 0.61 0.10, p < 0.001 and 0.80 0.03 vs. 0.82 0.03, p < 0.001, respectively). PPf was also found to be associated with AKI in univariable (odds ratio [OR] 2.183, 95% confidence interval [CI] 1.823-2.614, p < 0.001) and multivariable (OR 1.874, 95% CI 1.513-2.322, p<0.001) analysis. In-hospital mortality was higher in patients with AKI than those without. CONCLUSION: Invasively measured PPf, which can be easily measured and having no additional cost in STEMI patients undergoing coronary intervention, is an independent predictor of AKI. In addition, PPf is superior to other blood pressure values and derivatives in AKI prediction.