Noninvasive assessment of right ventricular–pulmonary artery coupling may predict acute kidney injury after primary PCI in STEMI patients

Acute kidney injury (AKI) after primary percutaneous coronary intervention (PCI) is associated with adverse clinical outcomes and remains a frequent complication in ST-elevation myocardial infarction (STEMI). Recent studies highlight the impact of impaired right ventricular (RV) function may contribute to AKI after PCI. We aimed to investigate the association between the RV-Pulmonary arterial (PA) coupling, evaluated by the tricuspid annular plane systolic excursion (TAPSE)/pulmonary arterial systolic pressure (PASP) ratio, and contrast-associated acute kidney injury (CA-AKI) in patients with STEMI. In this retrospective study, 256 consecutive STEMI patients who underwent primary PCI were included. Demographic, angiographic, laboratory and echocardiographic data, including the TAPSE/PASP ratio, were collected. CA-AKI was defined as an increase of ≥ 25% or ≥ 0.5 mg/dL in baseline (pre-PCI) serum creatinine at 48 h after PCI. The association between TAPSE/PASP and CA-AKI was evaluated using receiver operating characteristic (ROC) analysis and multivariable logistic regression. The mean age was 60.1 ± 8.8 years, and 60.5% of patients were male. CA-AKI was observed in 31 (12.1%) patients. The TAPSE/PASP ratio was significantly lower in patients with CA-AKI (p < 0.001). ROC analysis identified an optimal TAPSE/PASP cutoff of 0.52 mm/mmHg, with a sensitivity of 61.8%, a specificity of 90.3%. In multivariable analysis, the TAPSE/PASP ratio > 0.52 was independently associated with a lower risk of CA-AKI (Odds ratio 0.066 (95% confidence interval: 0.009–0.461 p = 0.006). RV–PA coupling assessed by the TAPSE/PASP ratio was independently associated with CA-AKI after primary PCI in patients with STEMI. This simple echocardiographic measure may aid early risk stratification for post-PCI AKI.