INTRODUCTION
There has been a constant association of adverse clinical 
outcome in myocardial infarction (MI) patients with acute 
kidney injury (AKI). AKI often complicates the hospital stay 

1and is prevalent in about 30% of cases admitted to ICU.  The 
incidence of AKI has surpassed the incidence of stroke and 
has increased by fourfolds in the U.S. since 1988 and is in a 
rising trend and will probably continue to do so in future as 

1well if proper measures are not taken.

Due to advancement in the eld of medical sciences in both, 
pharmacological as well as  revascularization therapy, the  
overall survival of   ST-elevation myocardial infarction 
(STEMI) patients has considerably improved in the last two 

10decades.  Presently the physician's focus is shifting on the 
subsets whose outcome after MI is still disappointing and 
mortality rate remains high.  Poor prognosis is associated in 
patients who develop AKI after MI.  However, management 
guideline of STEMI currently does not focus much attention on 

11AKI.  Therefore, this study was planned in view of providing a 
framework of reference to raise the awareness of AKI post MI 
to physicians, so as to improve the outcome of  STEMI patients 
with AKI.

Even though AKI is a frequent complication seen in the 
hospitals and is known to have a marked impact on morbidity 
and mortality, many important questions remain unanswered 
like whether AKI contributes to a high risk of cardiovascular 
events. As very few studies are conducted in this context and a 
lesser amount of knowledge regarding AKI's short-term effects 
after its occurrences as a complication of AMI.Thus, this study 
was performed to nd out the incidence of AKI in post MI 
patients and to study their clinical prole and the outcome of 
AKI in post MI.

MATERIALS AND METHOD: 
Prospective observational study was undertaken in 

Saraswathi Medical College and Hospital, Bareilly including 
100 patients   admitted in the medical ICU,emergency and 

st stward from 1 May 2019 to 31 Nov 2019.
    
Detailed history taking and clinical examination was 
performed and laboratoryinvestigations were done after 
explaining the nature of study and informed written consent 
taken from the patients. The following investigations were 
done: 
Ÿ Blood glucose: FBS, PPBS 
Ÿ Renal function tests
Ÿ Electrolytes
Ÿ Urine routine and microscopy
Ÿ Electrocardiography(ECG)
Ÿ Chest x-ray
Ÿ Echocardiography  
Ÿ Cardiac enzymes like troponin, CPK-MB

The data was collected, computed and statistically analyzed. 

RESULTS: 
Out of 100, 36 patients had AKI. Mean age of these patients 
was 53±5.9 years in patients with AKI and those without AKI 
were 50± 6.1years. Out of 100, 44 had inferior wall MI, 36 had 
anterior wall MI and 20 had NSTEMI. 

Fig. 1. Showing incidence of inferior wall , anterior wall MI 
and NSTEMI

AKI IN POST MI: A KILLER IN DISGUISE

Original Research Paper

Abhishek Kumar 
Verma 

Assistant Professor, MD Medicine, Saraswathi Medical College And Hospital, 
Hapur

General Medicine

INTRODUCTION: There has been a constant association of adverse clinical outcome in myocardial 
infarction (MI) patients with acute kidney injury (AKI). However, whether AKI contributes to an excess risk 

of cardiovascular events is still controversial, as very few studies are conducted in this context and less amount of knowledge 
regarding AKI's short-term effects after its occurrence as a complication of AMI, so this study was performed.
AIM: To nd the incidence of AKI in post MI patients, study their clinical prole and outcome of AKI in post MI patients.
MATERIAL AND METHOD: Prospective observational study was undertaken   in Saraswathi Medical College and Hospital, 
Bareilly including 100 patients   admitted in the ICU, emergency and ward from 1stMay 2019 to 31stNov 2019. They were 
subjected to careful history taking and detailed clinical examination; routine investigations were done. The data was 
computed and was statistically analyzed.
RESULTS: Out of 100, 36 patients had AKI. Mean age of the patients with AKI was 50± 6.1years and those  without AKI was 
53±5.9 years. Out of 100, 44 had inferior wall MI, 36 had anterior wall MI and 20 had NSTEMI.  Mean fasting blood glucose 
(mg/dL) in patients without AKI was 94.7±32 and in those with AKI was 145±40. Mean troponin I(ng/ml) was  2.4±3.4  in 
patients without AKI and 5.29±7.1in those with AKI which was found statistically signicant (p value=0.015). Mean urea 
(mg/dL) and creatinine (mg/dL) was 33.9±11.9 and 0.74±0.11 respectively in patients without AKI and with AKI was 70±48.9 
and 2±1.45 respectively. Patients with AKI after MI had a more number of complications like arrhythmia, heart failure, 
hypotension, LVEF (<30%), rupture (free wall or septum or papillary muscle) as compared to patients without AKI. Mortality in 
patients without AKI was 4 and in patients with AKI was 6 .
CONCLUSION: High troponin I and older age are the most important risk factors for AKI in patients with acute MI. Post-MI 
complications and mortality in patients with AKI was more than that in patients without AKI. Careful monitoring of susceptible 
patients in ICU is recommended for early detection and management of AKI in patients with MI. 

ABSTRACT

KEYWORDS : 

Kamlesh Taori*
Junior Resident, MD Medicine, Rohilkhand Medical College, Bareilly 
*Corresponding Author

Hetal Boricha MBBS, K.J. Somaiya Medical College, Mumbai

VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

16 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS



Incidence of AKI in acute MI is 36. Mean fasting blood glucose 
(mg/dL) was 94.7±32.1 in patients without AKI and with that of 
AKI was 145±40. Mean troponin I(ng/ml) was 2.4±3.4  in 
patients without AKI and with that of AKI was 5.29±7.1 which 
was found statistically signicant (p value=0.015). Mean urea 
(mg/dL) and creatinine (mg/dL) was 33.9±11.9 and 0.74±0.11 
respectively in patients without AKI and with that of AKI was 
70±48.9 and 2±1.45 respectively. 

Table 1. Clinical and Laboratory prole of patients with AKI 
and without AKI 

*is statistically signicant using Chi Square test

Patients with AKI after MI had  a more number of 
complications like arrhythmia, heart failure, hypotension, 
LVEF (<30%), rupture (free wall or septum or papillary muscle) 
as compared to patients without AKI as shown in the table 
below. 

Table 2. Complication in post-MI patients with AKI and 
without AKI 

*is statistically signicant using Chi Square test

Mortality in patients with AKI was 6 and in patients without AKI 
was 4, which was found to be statistically signicant. 

DISCUSSION:
The incidence of AKI increased by fourfolds in the United 
States since 1988 and is projected to have incidence of 500 per 
100,000 population annually, which is more than incidence of 
stroke annually. AKI is related to markedly increased risk of 
mortality in hospitalized patients, predominantly in those who 
were admitted to the ICU wherein mortality rates  could be 
more than 50%.[1]

Acute kidney injury (AKI) is dened by the impairment of 
kidney ltration and excretory function over days to weeks, 
resulting in retention of nitrogenous and other waste products 

1normally cleared by the kidneys.  By this denition the 
presence of AKI is dened by an elevation in the serum 
creatinine concentration or reduction in urine output. AKI is 
currently dened by a rise in serum creatinine from baseline of 
at least 0.3 mg/dL within 48 h or at least 50% higher than 
baseline within 1 week or a reduction in urine output to <0.5 

7mL/kg per h for longer than 6 h. 

2AKI leads to an increase in cardiac biomarkers of ischemia ; 
3also there is an increase in cytokines (inammatory) , 

4endothelial dysfunction  and dysregulation in mineral 
5, 6metabolism . In post MI patients, the complication of AKI, for 

example, dyselectrolytemia , hypervolumia, acidosis and 
others leads to increase in mortality and adverse outcome 
after MI.

In a study by , Fox CS  et al found that Kirsten E. Fleischmann
clinical factors,for example  heart failure, hypotension, and 
the majority cardiac risk factors; and the procedures such as 
coronary artery catheterization and coronary artery bypass 
grafting,were found associated with increasedrisk for AKI. 
They found that mortality was 2.1% in patients without AKI, as 
compared to patients with mild, moderate and severe AKI was 
6.6%, 14.2%, and 31.8% respectively. AKI was found to be 
associated with an increased risk of bleeding, i.e. 8.4% in 
patients without AKI and 32.7% in patients with severe AKI. [8]
Parikh RP, Steven G, Coca DO Yongfei MS; , et al found that AKI 
has a graded and independent association with long-term 
mortality. They concluded that mild, moderate and severe AKI 
was associated with a 15%, 23% and 33% increased risk of 
death respectively at 10 years. [9]

Thus, we conclude that AKI is a frequent complication in AMI 
that is associated with notable short- and long-term mortality. 
Post-MI complication and mortality in patients with AKI was 
more than that in patients without AKI. Careful monitoring of 
susceptible patients in ICU is recommended for early 
detection and management of AKI in those patients. 

CONCLUSION: 
High troponin I and older age are the most important risk 
factors for AKI in patients with acute MI. Post-MI complication 
and mortality in patients with AKI was more than that in 
patients without AKI. Careful monitoring of susceptible 
patients in ICU is recommended for early detection and 
management of AKI in those patients. 

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Infarction. Massachusetts. NEJM Journal Watch.2012

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Acute Kidney Injury After Acute Myocardial Infarction. Arch Intern Med. 
2008;168(9):987-995.

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Heart. 2013; 99: 1488-1493.

11. Task Force on the management of ST-segment elevation acute myocardial 
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VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

No AKI AKI P Value 

Age 50± 6.1 53±5.9 0.004*

Troponin I(ng/ml) 2.4±3.4 5.29±7.1 0.015*

CPK-MB
(ng/ml) 

65.3±84.9 44.1±76.5 0.19

Urea (mg/dl) 33.9±11.9 70±48.9 0.00002*

Creatinine
(mg/dl) 

0.74±0.11 2±1.45 0.000003*

Albumin
(g/dl) 

3.7±0.6 3.5±0.4 0.086

A/C ratio
(mg/g) 

84±58 99±86 0.16

Fasting Blood Glucose 
(mg/dl) 

94.7±32.1 145±40 0.013*

Complications Post-MI with 
AKI

Post MI 
without AKI

P- Value

Arrhythmia 5 (13.9%) 3 (4.7%) 0.048*

Heart Failure 6 (16.7%) 4 (6.3%) 0.046*

Hypotension 21 (58.3%) 19 (29.7%) <0.001*

LVEF (<30%) 11 (30.6%) 8 (12.5%) <0.001*

Rupture (free wall or 
septum or papillary 
muscle)

1 (2.8%) 0 (0%) 0.477

Death 6 (16.7%) 4( 6.3%) 0.0238*

  X 17GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS