Long-Term Clinical Outcome according to Changes of Glomerular Filtration Rate in AMI Patients with Multivessel Disease after Percutaneous Coronary Intervention

Abstract

Glomerular filtration rate (GFR) is an important indicator of renal failure. However, regarding delta GFR in acute myocardial infarction (AMI) is rare. In this study, it was examined whether the delta GFR had an adverse effect on outcomes in patients with AMI and multivessel disease (MVD). Among 13,105 consecutive patients enrolled in the Korea Acute Myocardial Infarction-National Institute of Health registry, 2619 with AMI and MVD who underwent percutaneous cardiac intervention (PCI) were assigned to the better delta GFR (group I, n=1432 [54.7%]) or worse delta GFR (group II, n=1187 [45.3%]) groups and followed for 3 or more years. The mean age of group I was lower than that of group II (62.64±11.52 years vs. 64.29±11.64 years; p<0.001). On multivariate analysis, delta GFR (hazard ratio, 1.50; 95% confidence interval, 1.05-2.13; p=0.024) was a negative risk factor for adverse cardiac events. Age over 65 years (p< 0.001), history of MI (p=0.008), low hemoglobin (p<0.001), high triglyceride (p=0.008), low high-density lipoprotein cholesterol (p=0.002), and low left ventricular ejection fraction (LVEF) (p<0.001) were prognostic factors for major adverse cardiac events (MACE). In patients with a GFR <60 mL/min/1.73 m 2 , mortality was increased by 0.9% in the multivessel PCI group and 0.7% in the IRA-only PCI group at the 1-year follow-up. According to the 3-year clinical follow-up analysis, prognosis was better in better delta GFR patients with AMI and MVD who underwent PCI than in worse delta GFR patients.

Machine Learning for Early Prediction of Major Adverse Cardiovascular Events After First Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction: Retrospective Cohort Study

“…Yang et al [ 32 ] found that the risk ratio of hospital deaths after PCI was 3.723 (95% CI 2.86-4.84) for South Korean patients aged >65 years relative to those aged ≤65 years. A Korean multicenter AMI National Institutes of Health–registered project found that the MACE rate, 3 years after PCI, among patients with AMI with an LVEF <40% was 3.34 times that of the control group [ 33 ]. Fam et al [ 34 ] conducted a retrospective study on patients with clinical AMI in Asian multiethnic groups and found that the risk of MACEs among patients with diabetes, 2 years after PCI, was 1.84 times higher than that among patients without diabetes [ 34 ].…”

Nomogram to Predict Outcomes After Staged Revascularization in ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

“…Both nomograms support previous studies and suggest that eGFR is an independent predictor of outcomes in STEMI patients with or without MVD treated with PCI. 18,19 Go AS et al found that the risk of all-cause mortality from cardiovascular adverse events (coronary heart disease, acute myocardial infarction, heart failure, and stroke) increased with the interval decrease in eGFR in a large-scale epidemiological 1718 study. 20 Most patients with STEMI and MVD require multiple PCI procedures with more contrast agents, implying a higher risk of contrast-induced nephropathy.…”