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

Abstract

Background and ObjectivesPatients with renal dysfunction (RD) experience worse prognosis after myocardial infarction (MI). The aim of the present study was to investigate the impact of admission estimated glomerular filtration rate (eGFR) on clinical outcomes of patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation MI (STEMI).Subjects and MethodsWe retrospectively evaluated 4,542 eligible patients from the Korea Acute Myocardial Infarction Registry (KAMIR). Patients were divided into three groups according to eGFR (mL/min/1.73 m2): normal renal function (RF) group (eGFR ≥60, n=3,515), moderate RD group (eGFR between 30 to 59, n=894) and severe RD group (eGFR <30, n=133). Baseline characteristics, angiographic and procedural results, and in-hospital outcomes between the three groups were compared.ResultsAge, gender, Killip class ≥3, hypertension, diabetes, congestive heart failure, peak creatine kinase-MB, high sensitivity C-reactive protein, B-type natriuretic peptide, left ventricle ejection fraction, multivessel disease, infarct-related artery and rate of successful PCI were significantly different between the 3 groups (p<0.05). With decline in RF, in-hospital complications developed with an increasing frequency (14.1% vs. 31.8% vs. 45.5%, p<0.0001). In-hospital mortality rate was significantly higher in the moderate and severe RD groups as compared to the normal RF group (2.3% vs. 13.9% vs. 25.6%, p<0.0001). Using multivariate logistic regression analysis, adjusted odds ratio for in-hospital mortality was 2.67 {95% confidence interval (CI) 1.44-4.93, p=0.002} in the moderate RD group, and 4.09 (95% CI 1.48-11.28, p=0.006) in the severe RD group as compared to the normal RF group.ConclusionDecreased admission eGFR was associated with worse clinical courses and it was an independent predictor of in-hospital mortality in STEMI patients undergoing primary PCI.

Impact of family history on the presentation and clinical outcomes of coronary heart disease: data from the Korea Acute Myocardial Infarction Registry

“…Model 2 included left ventricular ejection fraction (LVEF) in addition to the covariates in model 1 to reflect severity of infarction and/or baseline cardiac function at index admission. Model 3 included estimated glomerular filtration rate (eGFR), calculated from serum creatinine levels using the prediction equation from the Modification of Diet in Renal Disease Study Group [10] in addition to the covariates in model 2 because renal dysfunction was also assessed as an independent prognostic factor in previous studies [11,12]. All statistical procedures were performed using the PASW software version 18.0 (IBM Co., Armonk, NY, USA).…”

Renal dysfunction in STEMI-patients undergoing primary angioplasty: higher prevalence but equal prognostic impact in female patients; an observational cohort study from the Belgian STEMI registry

“…Chronic kidney disease, even mild, is associated with increased cardiovascular mortality [9]. More recently it was demonstrated that renal dysfunction is independently associated with in-hospital mortality in STEMI patients treated with pPCI [10-12]. …”

Renal insufficiency was correlated with 2-year mortality for rural female patients with ST-segment elevation acute myocardial infarction after reperfusion therapy: a multicenter, prospective study

“…Renal dysfunction is an independent risk factor for death in patients with STEMI [ 27 ]. And patients with renal dysfunction have been shown to have a 6 to 11-fold higher in-hospital mortality rate compared to patients with normal renal function [ 8 ]. These patients more commonly developed low left ventricular ejection fraction, higher Killip class, cardiogenic shock, hemodynamic instability or malignant arrhythmia during admission [ 28 ].…”

“…Widely used early reperfusion therapy, including emergency primary percutaneous coronary intervention (PCI) or thrombolysis therapy has beneficial effects for STEMI [ 3 , 4 ]. However, RI following STEMI is associated with a worse clinical prognosis [ 5 – 7 ], a 6 to 11-fold increase in hospital risk of death [ 8 ], and a 1.76- to 6.18-fold 7-month risk of death [ 6 ]. Unfortunately, most STEMI patients with RI are excluded from randomized trials.…”