Optimal management to prevent acute kidney injury in patients with acute coronary syndrome in the opinion of physicians from cardiology, nephrology and internal medicine departments – a multicentre survey study
Joanna Maksimczuk, Agata Galas, Paweł Krzesiński
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.