Time Is Kidney: Relation between Pain-to-Balloon Time and Acute Kidney Injury among ST Segment Elevation Patients Undergoing Primary Percutaneous Intervention

BACKGROUND: Among ST segment elevation myocardial infarction (STEMI), early hemodynamic changes may result in acute kidney injury (AKI) even prior to primary percutaneous coronary intervention (PCI); however, no information to date is present regarding the association between pain-to-balloon time (PBT) and AKI. We evaluated whether PBT predicts the risk of AKI among STEMI patients undergoing primary PCI. METHODS: Medical records of 2,343 STEMI patients undergoing primary PCI were reviewed. Patients were stratified by PBT into 3 groups: ≤120, 121-360, and >360 min. Patients' records were assessed for the occurrence of AKI (defined by the KDIGO criteria as serum creatinine (sCr) elevation ≥0.3 mg/dL within 72 h after admission). RESULTS: Mean age was 61 ± 13 years, and 1,919 (82%) were male. Patients having longer PBT had more AKI complicating the course of STEMI (7% vs. 8% vs. 13%, p < 0.001) and had significantly higher sCr changes throughout hospitalization (0.08 mg/dL vs. 0.11 mg/dL vs. 0.17 mg/dL p < 0.001). In a multivariable logistic regression model, each 1-h increase in PBT was independently associated with a 2.2% increase in risk for AKI (odds ratio 1.022, 95% confidence interval: 1.01-1.04, p = 0.02). CONCLUSION: Longer PBT may be an independent marker for the development of AKI in STEMI patients undergoing primary.