RELATIONSHIP OF THE FREQUENCY OF HOSPITAL COMPLICATIONS IN PATIENTS WITH MYOCARDIAL INFARCTION COMPLICATED BY CARDIOGENIC SHOCK WITH THE PRESENCE OF CHRONIC KIDNEY DISEASE

Abstract

Introduction. Chronic kidney disease (CKD) is a common concomitant condition in patients with acute myocardial infarction (AMI), complicating its course and treatment. Materials and methods.
93 patients with myocardial infarction complicated by cardiogenic shock were studied at the Altai Regional Cardiological Dispensary. 24 with AMI and CKD and 69 without CKD. Upon admission, complaints, clinical and anamnestic data were collected from all patients, and renal function was assessed using the CKD-EPI formula (KDIGO 2012) and creatinine clearance (CC) according to Cockroft–Gault. Echocardiography (EchoCG), electrocardiography (ECG), ultrasound of the kidneys, coronary angiography, assessment of hospital complications and correlations of the obtained indicators were performed. Results. In the group with CKD there was a greater number of recurrent myocardial infarction and chronic heart failure with low ejection fraction (HFrEF): 8 (33.3 %) versus 10 (14.4 %) patients in the group without CKD, p = 0.044, and 7 (29 %) and 9 (13 %) in the group without CKD, p = 0.035, respectively. Among the most common hospital complications of of myocardial infarction (MI), along with Killip IV in patients of the first group, the following were identified: atrial fibrillation and paroxysms of ventricular tachycardia 11 (45.8 %) and 20 (28.9 %), p = 0.021, and 6 (25 %) and 4 (5.7 %), p = 0.008, development of acute aneurysm of the anterior wall of the left ventricle — 3 (12.5 %) versus 1 (1.4 %), p = 0.021, recurrent MI 3 (12.5%) and 0 without renal dysfunction, p = 0.015, Killip III — 10 (41.6 %) in patients with CKD and 16 (23.1 %) without CKD, p = 0.006, stress hyperglycemia — 11 (45.8%) and 13 (18.8 %) groups without CKD, p = 0.009 and t he number of deaths 13 (54.1%) group with CKD and 21 (30.4) group without CKD, p = 0.037. Patients with CKD needed inotropic support for a longer period of time — 10 (41.6 %) compared to the group without CKD 12 (17.3 %), p = 0.015. Correlations were identified between the level of systolic blood pressure and creatinine (r = –0.2586, p = 0.046), and and glomerular filtration rate (GFR) according to CKD-EPI (positive relationship) (r = 0.3850, p = 0.002), as well as the relationship between creatinine with age (r = 0.21, p = 0.015); body mass index (BMI) (r = 0.2625, p = 0.043), left atrium size (r = 0.4593, p = 0.000), size of the left atrium (EF) (r = –0.3289, p = 0.010), end-diastolic dimen-sion (EDD) and end-systolic dimension (ESD) (r = 0.3206, p = 0.013) and (r = 0.3606, p = 0.005), respectively. CKD-EPI correlated with the level of diastolic blood pressure — (r = –0.3839, p = 0.002), age (r = –0.3348, p = 0.009); LP (r = –0.4940, p = 0.000); EF (r = 0.4351, p = 0.001); EDD (r = –0.2700, p = 0.037); ESD (r = –0.3709, p = 0.004). Conclusion. In patients with AMI complicated by cardiogenic shock, a history of CKD is associated with a higher incidence of va rious MI complications, including deaths. Correlations between indicators of renal function, echocardiography and objective data indicate a greater frequency and severity of left ventricular myocardial remodeling in patients with MI complicated by cardiogenic shock and a history of CKD.