Multivessel coronary artery disease (MVCAD) is found in approximately 50% of patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Although we have data showing the benefits of revascularization of significant non-culprit coronary lesions in patients with AMI, the optimal timing of angioplasty remains unclear. The most common reason for postponing subsequent percutaneous treatment is the fear of contrast-induced acute kidney injury (CI-AKI). Acute kidney injury (AKI) is common in patients with AMI undergoing PCI, and its etiology appears to be complex and incompletely understood. In this review, we discuss the definition, pathophysiology and risk factors of AKI in patients with AMI undergoing PCI. We present the impact of AKI on the course of hospitalization and distant prognosis of patients with AMI. Special attention was paid to the phenomenon of AKI in patients undergoing multivessel revascularization. We analyze the correlation between increased exposure to contrast medium (CM) and the risk of AKI in patients with AMI to provide information useful in the decision-making process about the optimal timing of revascularization of non-culprit lesions. In addition, we present diagnostic tools in the form of new biomarkers of AKI and discuss ways to prevent and mitigate the course of AKI.

Introduction and objective: Multivessel coronary artery disease affects approximately 50% of patients with acute coronary syndrome. Revascularisation should not only address the culprit lesion, but should include other significant coronary stenoses. The currently accepted approach involves performing a second angioplasty during hospitalisation due to acute coronary syndrome. The time that should elapse between two stages has not been established, and the concern about deterioration of renal function is a common reason for postponing the second angioplasty. The purpose of this study was to find out doctors’ opinions on the optimal management to prevent kidney injury in patients undergoing two-stage revascularisation. Materials and methods: The study was conducted in the form of an anonymous online survey. It was attended by 84 physicians from 6 centres offering invasive treatment of acute coronary syndromes. The questionnaire included 3 questions characterising respondents and 6 questions on kidney injury. Results: Physicians’ opinions varied, both on the main risk factors for acute kidney injury and on the optimal timing of the second percutaneous coronary intervention. The most frequently mentioned factors responsible for kidney injury included: baseline kidney dysfunction, hypoperfusion and heart failure. Almost half of the respondents believed that more than 48 hours should elapse between the two stages of revascularisation. Conclusions: Our study indicates the lack of standards for the management in patients with acute coronary syndrome qualified for staged revascularisation. Further studies are needed to determine the optimal timing of the second stage of angioplasty.