Impact of renal insufficiency on mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Abstract

BackgroundChronic kidney disease is associated with increased risk of mortality. We examined the impact of moderate and severe renal insufficiency (RI) on short- and long-term mortality among unselected patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).MethodsFrom January 1, 2002 to December 31, 2010 all patients with STEMI treated with primary PCI were identified. The hazard ratio (HR) for death was estimated using a Cox regression model, controlling for potential confounders. RI was defined as creatinine clearance (CrCl) < 60 mL/min (moderate RI: CrCl ≤30 < 60 mL/min and severe RI: CrCl < 30 mL/min).ResultsThe study cohort consisted of 4,116 patients of whom 898 (21.8%) had RI and 3,218 (78.2%) had a CrCl ≥ 60 mL/min. Compared to patients without RI, patients with RI were older, more often female and more likely to have diabetes mellitus, hypertension and to present with a higher Killip class.Among patients with a preserved kidney function and patients with RI, 30-day all-cause mortality was 3.5% vs. 20.9% (log-rank p < 0.001); 1-year all-cause mortality was 5.7% vs. 29.4% (log-rank p < 0.001); 5-year all-cause mortality was 13.4% vs. 47.4% (log-rank p < 0.001). Moderate and severe RI were associated with higher 1-year mortality compared to patients with a preserved renal function (CrCl ≤30 < 60 mL/min: adjusted HR 2.71 [95% CI 2.09-3.51], p < 0.001), and (CrCl < 30 mL/min: adjusted HR 7.09 [4.82-10.44], p < 0.001).ConclusionIn unselected STEMI patients treated with primary PCI, moderate and severe RI were associated with increased risk of mortality.

Impact of renal failure on all-cause mortality and other outcomes in patients treated by percutaneous coronary intervention

“…In addition, a 10 mL/min decrease in creatinine clearance has been shown to contribute as much as a 10-year increase in age to hospital death rates [16]. Compared with other reports, mortality was high in our unselected PCI population [17,18]. This may be explained by the fact that patients with cardiogenic shock were not excluded in our study, and probably by an increased mortality risk in non-randomized and all-comer patients in a reference centre compared with results from a randomized controlled study.…”

Impact of renal function on survival after transcatheter aortic valve implantation (TAVI): an analysis of the UK TAVI registry

“…Chronic kidney disease (CKD) is associated with adverse health outcomes in multiple populations4 and after a variety of surgical and invasive procedures, including percutaneous coronary intervention,5 coronary bypass surgery6 and SAVR 7. Large scale outcome data examining the impact of CKD on outcomes after TAVI are still lacking and studies to date have been inconsistent.…”

Impact of chronic kidney disease on the long-term prognosis of patients with atrial fibrillation undergoing coronary stenting

“…Renal dysfunction has been recognized as a prognostic factor in acute coronary syndrome irrespective of whether PCI was performed [8][9][10][11][12][13][14], and the GRACE score incorporates serum creatinine as a major component for risk stratification. However, its role in assessing the thromboembolic risk for AF patients has been debated.…”