The Effect of Door to Wire Crossing and the Incidence of Acute Kidney Injury in ST Segment Elevation Myocardial Infarction Patients Underwent Primary Percutaneous Coronary Intervention at H. Adam Malik Hospital Medan

Abstract

Background: ST segment elevation myocardial infarction (STEMI) causes hemodynamic changes  and an increase in endogenous vasoconstrictor release leads to renal arteriolar vasoconstriction and decreases renal perfusion and may causes acute kidney injury (AKI). Door to wire crossing is a very important prognostic marker in STEMI patients.

Aims: To assess the effect of door to wire crossing and the incidence of AKI in STEMI patients with onset <12 hours undergoing primary percutaneous coronary intervention (PCI) at H. Adam Malik General Hospital Medan.

Methods: This study is a cohort study conducted from October 2018 to July 2019 with study subjects of STEMI patients with onset <12 hours who underwent primary PCI that met the inclusion and exclusion criteria. Creatinine levels will be checked before and 48-72 hours after the primary PCI as well as the door to wire crossing will be recorded and compared.

Result: The incidence of AKI was found around 14% in the group with a door to wire crossing <140 minutes and by 39% in the group with a door to wire crossing> 140 minutes. It was found that the final urea (p = 0.03), creatinine (p = 0.01), CrCl (p = 0.004) and changes in creatinine (p = 0.008) were statistically significant, while the contrast volume was not. In addition, the door to wire cossing >140 minutes (OR: 4.6; p = 0.032), hypertension (OR: 5.96; p = 0.018) and STEMI onset >6 hours (OR: 7.3; p = 0.019) emerged as independent predictors of AKI.

Conclusion: STEMI patients with onset <12 hours who underwent primary PCI with the door to wire cossing >140 minutes have 4.6 times likelihood to develop AKI rather than those with door to wire cossing <140 minutes. The incidence of AKI ranges from 14% -39%. The independent predictors of AKI besides door to wire crossing are hypertension and STEMI's onset.