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AMBULATORY ARTERIAL STIFFNESS INDEX AS PREDICTOR OF IN-HOSPITAL RENAL DYSFUNCTION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Mantzouranis, E.; Tsioufis, C.; Konstantinou, K.; Koumelli, A.; Kasiakogias, A.; Fragoulis, C.; Kalos, T.; Leontsinis, I.; Tolis, P.; Tolis, E.; Vogiatzakis, N.; Tousoulis, D.

doi: 10.1097/01.hjh.0000573848.38602.0c
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Objective: The ambulatory arterial stiffness index (AASI) is a marker of arterial stiffness, predicts cardiovascular morbidity and mortality in hypertensive patients and is associated with indices of target organ damage. However, data is scarce regarding the prognostic role of AASI for renal dysfunction in patients with myocardial infarction (MI).We therefore evaluated the relationship between AASI and worsening of renal function (WRF)in patients suffering a MI.

Design and method: We studied 197 patients [78.7% male; mean age 62.44 years; 68.5% hypertensives; 27.9% with diabetes mellitus (DM)] who were hospitalized because of ST-elevation myocardial infarction (STEMI, 50.3%) and NonST–elevation myocardial infarction (NSTEMI). All patients underwent baseline estimation of clinical and laboratory parameters during their hospitalization. Moreover, patients underwent 24-h ambulatory BP monitoring during the third day of hospital stay. AASI was measured according to established methodology. WRF was defined as a reduction of GFR > or = 25% according to the RIFLE criteria using MDRD formula.

Results: AASI demonstrated a prognostic role for WRF in the entire population (HR, 0.094; CI, 0.026–0.161; p = 0.007). After separate analysis for STEMI and

NSTEMI groups, AASI was a significant predictor for WRF in the STEMI group(HR, 0.087; CI, 0.004–0.170; p = 0.04) with a tendency in the NSTEMI one (p = 0.08). Therefore, a model of multivariate regression analysis was conducted for the entire population and STEMI group, where AASI retained its significant role as a predictor of WRF (OR, 0.097; CI, 0.034–0.157; p = 0.003 and OR, 0.104; CI, 0.020–0.187; p = 0.016 respectively), independently of age, gender, history of hypertension, history of DM and low density lipoprotein (LDL-C).

Conclusions: According to our study AASI is an independent predictor of in-hospital renal dysfunction in patients with MI. More data and research are required to determine the usefulness of this non-invasive tool in clinical practice in general population and in patients with MI.

First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, GREECE

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