Association of Renal Insufficiency With In-Hospital Mortality Among Japanese Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Interventions

Abstract

SUMMARY Itis not yet clear whether a difference in in-hospital morality between patients with and without renal insufficiency undergoing percutaneous coronary intervention (PCI) exists. Therefore, the aim of the present study was to investigate if such as association exists in Japan. Data from the Tokai Acute Myocardial Infarction Study II were used. This was a prospective study of all 3274 patients admitted with acute myocardial infarction (AMI) to the 15 participating hospitals from 2001 to 2003. We abstracted the baseline and procedural characteristics as well as in-hospital mortality from detailed chart reviews. Patients were stratified into 2 groups according to the estimated creatinine clearance on admission. The creatinine clearance values were available in 2116, 107 of whom had renal insufficiency. The patients with renal insufficiency were more likely to be older, female, not independent in their daily activities, have lower body mass index and higher heart rate values on admission, lower prevalences of hypercholesterolemia and peptic ulcers, greater prevalences of diabetes, angina, previous heart failure, previous renal failure, previous cerebrovascular disease, aortic aneurysm, worse clinical course such as bleeding, and a multivessel coronary disease. Vasopressors, an intra-aortic balloon pump, and mechanical ventilation were frequently used in the patients with renal insufficiency, while thrombolytics were used less frequently. The patients with renal insufficiency had a higher inhospital mortality rate than those without. Multivariate analysis identified renal insufficiency as an independent predictor of in-hospital death. The results suggest that renal insufficiency is an independent predictor of in-hospital death among AMI patients undergoing PCI. (Int Heart J 2006; 47: 745-752)

Decreased Glomerular Filtration Rate is an Independent Predictor of In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

“…In addition to older age and female gender, RD was more frequently associated with hypertension, diabetes, higher Killip class, multivessel disease and low left ventricular ejection fraction. These findings which have been described by other authors13)19)21) predispose to worse clinical outcomes after AMI. However, after adjustment for baseline differences, increased in-hospital mortality persisted in the patients with RD, suggesting that an increased mortality in patients with RD was not fully explained by these associated conditions, and that RD is a strong independent predictor of in-hospital mortality.…”

“…Although RD, as defined by either serum creatinine level or estimated GFR, has been associated with increased mortality in patients with AMI,13-15)18)19)21) serum creatinine level is insensitive for an early detection of RD and could underestimate the incidence of moderate or severe RD concealed behind the near-normal creatinine levels,9)22)23) thereby underscoring the risk of RD in AMI patients. Furthermore, a graded risk of RD clearly exists, RF should be classified into at least 3 groups using estimated GFR for appropriate RD risk stratification in clinical practice.…”

Renal Dysfunction was an Independent Predictor of In-Hospital Death and Ventricular Rupture in Patients With Acute Myocardial Infarction

“…RD is reported to be an independent predictor in AMI patients undergoing PCI [16, 17, 25]. Kim et al reported that the multivariable OR (95% CI) of In-HD was 2.67 (1.44 - 4.93, P = 0.002) for patients with eGFR of 30 - 59 mL/min/1.73m 2 , and 4.09 (1.48 - 11.28, P = 0.006) for those with eGFR < 30 mL/min/1.73m 2 compared to those with eGFR ≥ 60 mL/min/1.73 m 2 in AMI patients [18].…”

“…Japanese Coronary Intervention Study Group observed risk factors of In-HD including attempted PCI to left main coronary artery (LMC) disease, LV dysfunction, LMC disease, older age, multi-vessel disease, cerebrovascular disease, and diabetes as independent predictors [6]. In addition, many predictors of In-HD were pointed in AMI patients: female sex [7-12], diabetes [13, 14], obesity [15], and renal dysfunction (RD) [16-19]. …”

Clinical Factors Associated with In-Hospital Mortality in Patients with Acute Myocardial Infarction Who Required Intra-Aortic Balloon Pumping

“…Impaired renal function has been recognized as the determinant of in-hospital death in patients with AMI. 13,14) Since impaired renal function was associated with multiple risk factors, such as hypertension, diabetes mellitus, and smoking, 15,16) patients with AMI and impaired renal function might have advanced atherosclerosis, which was not evaluated in the present study. Furthermore, low eGFR levels in the "in-hospital death group" might be a result of malperfusion following CS.…”