Objective To investigate the long-term prognostic implications of contrast-induced acute kidney injury (CI-AKI) with transient or persistent renal dysfunction in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). Design A retrospective observational registry study. Setting Clinical follow-up after PCI. Patients and methods A total of 1041 PCI-treated AMI patients from the Infarction Prognosis Study registry. CI-AKI was defined as an increase in serum creatinine (>25% or >0.5 mg/dl (>44.2 μmol/l)) within 2 days after PCI. Main outcome measures Two-year cumulative event rate of all-cause death or renal failure requiring dialysis. Results CI-AKI was observed in 148 patients (14.2%). Patients with CI-AKI had a higher rate of death or dialysis (25.4% vs 6.3%, p<0.001) at 2 years compared with patients without CI-AKI. CI-AKI was an important independent predictor of death or dialysis (HR 2.76, 95% CI 1.61 to 4.73, p<0.001) Persistent renal dysfunction after CI-AKI was documented in 68 patients (45.9%). Patients with transient renal dysfunction showed a lower 2-year event rate of death or dialysis compared with those with persistent renal dysfunction (17.9% vs 34.1%, p=0.013); however, they showed a higher event rate compared with those without CI-AKI (17.9% vs 6.3%, p<0.001). Conclusion Transient and persistent renal dysfunction after CI-AKI was associated with increased short and long-term mortality and morbidity in AMI patients treated by PCI. Better preventive strategies are needed to improve clinical outcomes in AMI patients at high risk of developing CI-AKI.

Background: Contrast‐induced nephropathy (CIN) has been generally considered to be transient and associated with unfavorable clinical outcomes.Hypothesis: The aim of this study was to investigate whether Mehran risk score could predict CIN with persistent renal dysfunction and long‐term clinical outcomes in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI).Methods: We analyzed the clinical data of 1041 AMI patients. The primary end point was defined as major adverse cardiovascular and cerebrovascular event (MACCE) including death, reinfarction, target vessel revascularization, heart failure requiring hospital admission, and stroke. Patients were categorized into 4 groups according to risk scores: low (≤ 5, n = 596), moderate (6–10, n = 265), high (11–15, n = 111), and very high (≥16, n = 69).Results: Among the 148 patients (14.2%) who developed CIN, persistent renal dysfunction was observed in 68 patients. Presence in high‐ or very high‐risk groups was the most important independent risk factor of CIN with persistent renal dysfunction (odds ratio: 3.35, 95 confidence interval [CI]: 1.89–5.92, P < 0.001). Furthermore, patients in higher‐risk groups experienced significantly more MACCE and mortality 2 years after PCI. Using multivariate analysis, significant increase in the hazard ratio (HR) for MACCE was noted in moderate‐ (HR: 1.40, 95% CI: 0.97–2.03, P = 0.075), high‐ (HR 1.96, 95% CI: 1.22–3.15, P = 0.006), and very high‐risk (HR 2.40, 95% CI: 1.36–4.21, p = 0.002) groups, compared with the low‐risk group. The very high‐risk group had approximately 6‐fold increase in mortality over the low‐risk group (HR: 6.22, 95% CI: 2.77–13.95, P < 0.001).Conclusions: Mehran risk score predicted CIN with persistent renal dysfunction and long‐term clinical outcomes in patients with AMI.Drs. Jin Wi and Young‐Guk Ko contributed equally to the preparation of the article.This study was supported partly by grants from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (No. A085012, A102064, and A110879); the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (No.A08 5136); Yonsei University (6‐2009‐0008); Korea Institute of Medicine; and the Cardiovascular Research Center, Seoul, Korea.The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Background: Left ventricular (LV) diastolic dysfunction may be a mechanism of left atrial (LA) electroanatomical remodeling in atrial fibrillation (AF). We evaluated the association between LV diastolic function and LA mechanical function in non-valvular paroxysmal AF (PAF). Methods and Results: In 286 patients with PAF (males 73%, 57±11 years), LA size, indexed LA volume, LV diastolic function, and LA appendage flow velocity (LAA-FV) in sinus rhythm were measured using transthoracic echocardiography, transesophageal echocardiography and cardiac computed tomography. The LA voltage map was obtained using NavX contact mapping. Patients with impaired LA mechanical function (LAA-FV <58cm/s, n=142) showed a higher E/Em ratio (10.3 vs. 9.2, P=0.034) and lower Em velocity (6.8 vs. 7.7cm/s, P=0.004) than those with preserved function (LAA-FV ≥58cm/s, n=144). The patient population displayed weak correlations of E/Em with LAA-FV (r=-0.19, P=0.003) and LA voltage (r=-0.23, P=0.004), but more significant association of E/Em and LAA-FV (r=-0.39, P<0.001) for age ≥55 years and LA diameter ≥40mm. E/Em was an independent predictor of LAA mechanical function (β=-0.20, P=0.013) even after age, sex, LA size and comorbidities were controlled for. Conclusions: In patients with non-valvular PAF, LA mechanical function is closely related to the degree of LA remodeling and LV diastolic function. Impaired LV diastolic function significantly contributes to LA electoanatomical remodeling in older patients with a larger LA. (Circ J 2013; 77: 697–704)

Atrial fibrillation (AF) is considered to be associated with poor clinical outcomes in patients with acute myocardial infarction (AMI). However, it remains uncertain whether transient new-onset AF (NOAF) during AMI has a subsequent increased risk of poor clinical outcomes. Transient NOAF was defined as AF that developed during AMI without a prior history and not documented for 1 month after discharge. The primary endpoints were major adverse cardiac events (MACE) and all-cause death. We enrolled 2,105 consecutive AMI patients. Overall, AF was observed in 209 (9.9%) and transient NOAF occurred in 102 (4.8%) among 150 patients (7.1%) with NOAF. The transient NOAF group showed higher 1-month (21.8 vs. 7.0%, P<0.001), 2-year (37.8 vs. 20.7%, P<0.001), and 5-year MACE rates (51.8 vs. 28.0%, P<0.001) than the group without AF. In-hospital (16.7 vs. 5.2%, P<0.001), 1-month (17.9 vs. 5.7%, P<0.001), 2-year (30.0 vs. 11.6%, P<0.001), and 5-year mortality rates (36.9 vs. 14.0%, P<0.001) were also higher in patients with transient NOAF. Transient NOAF was a significant independent predictor of both MACE (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.10-2.18, P=0.013) and death (HR 1.87, 95% CI 1.22-2.85, P=0.004). Transient NOAF was associated with the poorer clinical outcomes and was an important independent predictor of MACE and death in AMI patients. (Circ J 2016; 80: 1615-1623).