Patient clinical characteristics.

Acute myocardial infarction is an acute-stage disease that requires prompt diagnosis and treatment. Primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) is a high-risk factor for post-contrast acute kidney injury (PC-AKI). This retrospective cohort study analyzed the data of 754 patients with STEMI who underwent pPCI and were integrated into the Fast Interrogation Rule for STEMI critical pathway program between 2015 and 2019. We aimed to determine the optimal cutoff baseline eGFR for identifying a high risk of PC-AKI after multivariable adjustment with statistically significant risk factors. We also compared the incidence rates of PC-AKI between the previous and current diagnostic criteria. The probability of PC-AKI increased when the baseline estimated glomerular filtration rate (eGFR) was ≤ 79mL/min/1.73 m2. The optimal cutoff baseline eGFR for high risk of PC-AKI was found to be an eGFR of ≤ 61 mL/min/1.73 m2 after multivariable adjustment. The current diagnostic criteria more accurately identified the patient group with impaired renal function. Our results have clinically significant implications for identifying patients at a high risk of developing PC-AKI, especially before and after the use of contrast agents in patients who require PCI for STEMI in the emergency department.

急性心肌梗死（Acute myocardial infarction）是一类需及时诊断与治疗的急性期疾病。针对ST段抬高型心肌梗死（ST-elevation myocardial infarction, STEMI）的直接经皮冠状动脉介入治疗（Primary percutaneous coronary intervention, pPCI）是造影剂相关急性肾损伤（post-contrast acute kidney injury, PC-AKI）的高危诱发因素。本回顾性队列研究对2015至2019年间，入组STEMI关键路径快速筛查项目（Fast Interrogation Rule for STEMI critical pathway program）的754例行pPCI的STEMI患者数据进行了分析，旨在通过多变量校正结合具有统计学意义的危险因素，明确可识别PC-AKI高风险人群的最佳基线估算肾小球滤过率（estimated glomerular filtration rate, eGFR）临界值；同时对比新旧两种诊断标准下PC-AKI的发病率差异。研究结果显示，当基线eGFR≤79mL/min/1.73 m²时，PC-AKI的发生概率显著升高；经多变量校正后，识别PC-AKI高风险的最佳基线eGFR临界值为≤61 mL/min/1.73 m²。相较于既往诊断标准，现行诊断标准可更精准地识别肾功能受损患者群体。本研究结果对于识别PC-AKI高风险人群具有重要临床指导价值，尤其适用于急诊科需行经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）的STEMI患者在造影剂使用前后的风险评估场景。