Noninvasive assessment of right ventricular–pulmonary artery coupling may predict acute kidney injury after primary PCI in STEMI patients

BACKGROUND: Acute kidney injury (AKI) after primary percutaneous coronary intervention (PCI) is associated with adverse clinical outcomes and remains a frequent complication in ST-elevation myocardial infarction (STEMI). Recent studies highlight the impact of impaired right ventricular (RV) function may contribute to AKI after PCI. We aimed to investigate the association between the RV-Pulmonary arterial (PA) coupling, evaluated by the tricuspid annular plane systolic excursion (TAPSE)/pulmonary arterial systolic pressure (PASP) ratio, and contrast-associated acute kidney injury (CA-AKI) in patients with STEMI. METHODS: In this retrospective study, 256 consecutive STEMI patients who underwent primary PCI were included. Demographic, angiographic, laboratory and echocardiographic data, including the TAPSE/PASP ratio, were collected. CA-AKI was defined as an increase of ≥ 25% or ≥ 0.5 mg/dL in baseline (pre-PCI) serum creatinine at 48 h after PCI. The association between TAPSE/PASP and CA-AKI was evaluated using receiver operating characteristic (ROC) analysis and multivariable logistic regression. RESULTS: The mean age was 60.1 ± 8.8 years, and 60.5% of patients were male. CA-AKI was observed in 31 (12.1%) patients. The TAPSE/PASP ratio was significantly lower in patients with CA-AKI (p < 0.001). ROC analysis identified an optimal TAPSE/PASP cutoff of 0.52 mm/mmHg, with a sensitivity of 61.8%, a specificity of 90.3%. In multivariable analysis, the TAPSE/PASP ratio > 0.52 was independently associated with a lower risk of CA-AKI (Odds ratio 0.066 (95% confidence interval: 0.009–0.461 p = 0.006). CONCLUSION: RV–PA coupling assessed by the TAPSE/PASP ratio was independently associated with CA-AKI after primary PCI in patients with STEMI. This simple echocardiographic measure may aid early risk stratification for post-PCI AKI.