Association of Glomerular Filtration Rate With Unsuccessful Primary Percutaneous Coronary Intervention and Subsequent Mortality in Patients With Acute Myocardial Infarction From the HIJAMI Registry

Abstract

umerous randomized trials have successfully demonstrated the beneficial effects of early percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI). [1][2][3] However, most patients with complications of renal insufficiency were excluded from randomized trials; therefore, the clinical effects of PCI for these patients have not been determined.In the past decade, patients with end-stage renal disease were associated with a decreased procedural success rate. [4][5][6] The development of device technology has provided better procedural outcomes after PCI in such patients 7-9 ; however, little is known regarding the impact of varying degrees of renal insufficiency on the success rate of emergency PCI in patients with AMI.As noted in a recent study, the success of PCI is a prime determinant of the clinical outcome of patients with AMI. 10 However, renal insufficiency is associated with a worse clinical outcome in patients with coronary artery disease including AMI. [11][12][13][14][15][16] It is also unclear whether successful PCI provides a better prognosis of AMI even in patients Circulation Journal Vol.72, February 2008 with renal insufficiency.The aims of this study were: (1) to determine the association between renal insufficiency and the risk of unsuccessful primary PCI in AMI patients; and (2) to evaluate the correlation between unsuccessful primary PCI and the clinical outcomes at various levels of renal function. Methods Study PopulationThe subjects of the present study were selected from the Heart Institute of Japan Acute Myocardial Infarction Registry (HIJAMI) database. Full details of the HIJAMI registry have been described elsewhere. 17 In brief, HIJAMI is a multicenter prospective cohort of consecutive patients with AMI who were admitted within 48 h after the onset of symptoms. Between January 1999 and July 2001, 3,021 consecutive patients from 17 participating hospitals in Japan were registered. As HIJAMI was meant for observational purposes, treatment strategies, such as drug therapies and early reperfusion treatment, were used at the discretion of the physician responsible at each hospital. Clinical and angiographic data, including the patients' demographics, coronary risk factors, therapeutic modalities, complications, number of diseased vessels, infarct-related arteries, PCI strategies, laboratory data and in-hospital outcomes were prospectively collected using a standardized case report form. Serum creatinine concentrations and C-reactive protein were measured at each site immediately after admis-

Clinical Outcomes and Therapeutic Strategy in Patients With Acute Myocardial Infarction According to Renal Function Data From the Korean Acute Myocardial Infarction Registry

“…[23][24][25] This work confirms those findings in unselected patients, despite considerable advances of modern pharmaceutical treatment in acute MI. We show that, as well as thrombolytic agent, medications with risk benefit after MI, are used less frequently during the index hospitalization and follow-up periods with declining renal function.…”

“…17,22,23 As a medical treatment, this is partly associated with advanced age, increased comorbidity and more compromised hemodynamic status in decreased renal function. 26 Wright et al described that patients with any degree of renal dysfunction are more likely to have contraindications to thrombolytic therapy than those without renal dysfunction.…”

Levels of Circulating Microparticles in Patients with Chronic Cardiorenal Disease

“…CRS, which is now widely accepted to be a distinct clinical entity 2, 3) affecting patients with cardiovascular disease in different clinical settings [2][3][4][5][6][7] , is particularly associated with a poor prognosis in individuals with acute coronary syndrome [4][5][6][7][8] . Numerous epidemiologic and clinical observational studies have revealed a substantially increased risk of cardiovascular events in patients with chronic kidney disease (CKD) 2-6, 9, 10) , and observational studies have identified cardiovascular disease as the leading cause of death among patients with renal failure, especially those on dialysis [11][12][13][14] .…”

Decreased glomerular filtration rate is a significant and independent risk for in-hospital mortality in Japanese patients with acute myocardial infarction: report from the Hokkaido acute myocardial infarction registry

“…The risks of CKD included not only the progression to end-stage renal failure but also the occurrence of adverse cardiovascular outcomes. [5][6][7][8][9] Previous studies have demonstrated that CKD is an independent risk factor for morbidity and mortality in the general population, 10 as well as in patients with cardiovascular diseases such as post acute myocardial infarction (AMI). 11 Anavekar et al 11 reported that CKD was a common and significant independent risk factor for cardiovascular events in AMI patients based on data from the Valsartan in Acute Myocardial Infarction Trial (VALIANT).…”