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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Registry-defined incident chronic kidney disease following acute kidney injury after primary PCI for STEMI and its association with long-term outcomes: a multicenter landmark analysis

  • Yong-Lee Kim1,2
  • Jeong Yoon Jang1
  • Jae Seok Bae1
  • Yun-Ho Cho1
  • Yujin Shin1
  • Han Ra Choi1
  • Hyeong Joo Lee1
  • Min Seok Noh1
  • Jeong Rang Park2
  • Min Gyu Kang2
  • Hye-Ree Kim2
  • Hyo Jin Lee2
4 more authors
  • Kye-Hwan Kim2
  • Jin-Yong Hwang2
  • Sung-Eun Park3
  • Jong-Hwa Ahn1
  1. 1Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital
  2. 2Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital
  3. 3Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital
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Abstract

Background: Acute kidney injury (AKI) frequently occurs in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Kidney recovery after AKI is heterogeneous, and the prognostic significance of kidney dysfunction persisting to the 3−6-month assessment remains incompletely defined. We evaluated whether registry-defined incident chronic kidney disease (CKD) following AKI was associated with subsequent death and myocardial infarction (MI).

Methods: This retrospective analysis of a prospectively collected multicenter PCI registry included STEMI patients treated with primary PCI between January 2010 and November 2020. AKI was defined according to KDIGO criteria. Kidney trajectory was classified as no AKI, transient AKI with recovery, or registry-defined incident CKD following AKI based on kidney function assessed at 3–6 months. To minimize guarantee-time bias, Kaplan–Meier and Cox analyses began at a 6-month landmark. Multivariable Cox models adjusted for age, sex, diabetes mellitus, LVEF, and baseline MDRD eGFR.

Results: Among 1,239 patients, 941 had no AKI, 56 had transient AKI, and 242 had incident CKD following AKI; the overall AKI incidence was 24.1%. The strict 6-month landmark cohort comprised 1,129 patients (869 no AKI, 48 transient AKI, and 212 incident CKD). Compared with no AKI, incident CKD was associated with all-cause death (multivariable Cox HR 4.06, 95% CI 1.23–13.45; P = 0.022), MI (multivariable Cox HR 4.49, 95% CI 1.79−11.30; P = 0.001), and death and/or MI (multivariable Cox HR 4.35, 95% CI 2.07−9.14; P < 0.001), whereas transient AKI was not significantly associated with these outcomes. In the two-group analysis, incident CKD was similarly associated with death (multivariable Cox HR 3.44, 95% CI 1.18−10.06; P = 0.024), MI (multivariable Cox HR 3.75, 95% CI 1.59−8.87; P = 0.003), and death and/or MI (multivariable Cox HR 3.61, 95% CI 1.83−7.14; P < 0.001).

Conclusions: Registry-defined incident CKD after in-hospital AKI identified a subgroup of STEMI survivors with substantially higher post-landmark risks of death and MI. Kidney recovery trajectory may provide clinically useful prognostic information beyond the occurrence of AKI alone.

Trial registration: ClinicalTrials.gov identifier: NCT04650529. Registered on 25 January 2021. Retrospectively registered.

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Cite

BibTeXRIS
BibTeX
@article{kim2026registrydefined,
  title = {{Registry-defined incident chronic kidney disease following acute kidney injury after primary PCI for STEMI and its association with long-term outcomes: a multicenter landmark analysis}},
  author = {Yong-Lee Kim and Jeong Yoon Jang and Jae Seok Bae and Yun-Ho Cho and Yujin Shin and Han Ra Choi and Hyeong Joo Lee and Min Seok Noh and Jeong Rang Park and Min Gyu Kang and Hye-Ree Kim and Hyo Jin Lee and Kye-Hwan Kim and Jin-Yong Hwang and Sung-Eun Park and Jong-Hwa Ahn},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fcvm.2026.1933650},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1933650/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Registry-defined incident chronic kidney disease following acute kidney injury after primary PCI for STEMI and its association with long-term outcomes: a multicenter landmark analysis
AU  - Yong-Lee Kim
AU  - Jeong Yoon Jang
AU  - Jae Seok Bae
AU  - Yun-Ho Cho
AU  - Yujin Shin
AU  - Han Ra Choi
AU  - Hyeong Joo Lee
AU  - Min Seok Noh
AU  - Jeong Rang Park
AU  - Min Gyu Kang
AU  - Hye-Ree Kim
AU  - Hyo Jin Lee
AU  - Kye-Hwan Kim
AU  - Jin-Yong Hwang
AU  - Sung-Eun Park
AU  - Jong-Hwa Ahn
PY  - 2026
DA  - 2026/10/27
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1933650
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1933650/full
AB  - Background: Acute kidney injury (AKI) frequently occurs in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Kidney recovery after AKI is heterogeneous, and the prognostic significance of kidney dysfunction persisting to the 3−6-month assessment remains incompletely defined. We evaluated whether registry-defined incident chronic kidney disease (CKD) following AKI was associated with subsequent death and myocardial infarction (MI).  Methods: This retrospective analysis of a prospectively collected multicenter PCI registry included STEMI patients treated with primary PCI between January 2010 and November 2020. AKI was defined according to KDIGO criteria. Kidney trajectory was classified as no AKI, transient AKI with recovery, or registry-defined incident CKD following AKI based on kidney function assessed at 3–6 months. To minimize guarantee-time bias, Kaplan–Meier and Cox analyses began at a 6-month landmark. Multivariable Cox models adjusted for age, sex, diabetes mellitus, LVEF, and baseline MDRD eGFR.  Results: Among 1,239 patients, 941 had no AKI, 56 had transient AKI, and 242 had incident CKD following AKI; the overall AKI incidence was 24.1%. The strict 6-month landmark cohort comprised 1,129 patients (869 no AKI, 48 transient AKI, and 212 incident CKD). Compared with no AKI, incident CKD was associated with all-cause death (multivariable Cox HR 4.06, 95% CI 1.23–13.45; P = 0.022), MI (multivariable Cox HR 4.49, 95% CI 1.79−11.30; P = 0.001), and death and/or MI (multivariable Cox HR 4.35, 95% CI 2.07−9.14; P < 0.001), whereas transient AKI was not significantly associated with these outcomes. In the two-group analysis, incident CKD was similarly associated with death (multivariable Cox HR 3.44, 95% CI 1.18−10.06; P = 0.024), MI (multivariable Cox HR 3.75, 95% CI 1.59−8.87; P = 0.003), and death and/or MI (multivariable Cox HR 3.61, 95% CI 1.83−7.14; P < 0.001).  Conclusions: Registry-defined incident CKD after in-hospital AKI identified a subgroup of STEMI survivors with substantially higher post-landmark risks of death and MI. Kidney recovery trajectory may provide clinically useful prognostic information beyond the occurrence of AKI alone.  Trial registration: ClinicalTrials.gov identifier: NCT04650529. Registered on 25 January 2021. Retrospectively registered.
SN  - 2297-055X
ER  -