Prognostic impact of renal dysfunction on long-term mortality in patients with preserved, moderately impaired and severely impaired left ventricular systolic function following myocardial infarction

Abstract

Objective:The aim of this study was to investigate and compare the prognostic impact of renal dysfunction (RD) at admission in patients with preserved, moderately impaired and severely impaired left ventricular systolic function following ST-elevation myocardial infarction (STEMI).Methods:We included 2436 patients with STEMI treated with primary percutaneous coronary intervention (pPCI). Patients presenting with cardiogenic shock and those on hemodyalisis were excluded. According to the left ventricular ejection fraction (EF), patients were divided in three groups: preserved left ventricular systolic function – EF >50%, moderately impaired – EF=40%-50% and severely impaired left ventricular systolic function-EF <40%. RD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 at admission. The follow-up period was 6 years.Results:Preserved, moderately impaired and severely impaired systolic function were found in 741 (30.5%), 1367 (56.1%) and 328 (13.4%) patients, respectively. RD was present in 105 (14.2%) patients with preserved systolic function, 247 (18.1%) patients with moderately impaired, and 120 (36.5%) patients with severely impaired systolic function.Regardless of the presence of RD, 6-year mortality rates in patients with preserved, moderately impaired, and severely impaired systolic function were 2.7%, 5.2% and 31.1% respectively. Within each LVEF group, patients with RD had a worse outcome, both in the short- and long-term. In the Mulivariate Cox Analysis, RD remained an independent predictor of 6-year mortality in patients with moderately (HR 2.52, 95% CI 1.54-3.78) and severely impaired systolic function (HR 2.84, 95% CI 1.68-5.34), but not in patients with preserved left ventricular systolic function (HR 0.59, 95% CI 0.14-1.41).Conclusion:Although patients with RD had higher 6-year mortallity following STEMI regardless of LVEF, RD at admission remained a strong independent predictor for 6-year mortality only in patients with moderately and severely impaired left ventricular systolic function.

Renal functions and prognosis in acute myocardial infarction. Concomitant left ventricular dysfunction should have been taken into account

“…In HORIZONS-AMI trial ( 3 ), LVEF <40% at admission was an independent predictor of 1-year mortality in patients with STEMI, whereas LVEF of 40%-50% was not related with negative outcomes. Methodologically, in the current study of Savic et al ( 1 ), the prognostic impact of LVEF on long-term mortality was not analyzed separately, if anything, along with the presence of baseline RD. On the contrary, in this study, the LVEF values were determined after primary PCI, and not at admission.…”

“…In the current study entitled “Prognostic impact of renal dysfunction on long-term mortality in patients with preserved, moderately impaired, and severely impaired left ventricular systolic function following myocardial infarction. Anatol J Cardiol 2018; 20: 21-8.” Savic et al ( 1 ), have evaluated the prognostic impact of renal dysfunction (RD) at admission in patients with preserved, moderately, and severely impaired left ventricular systolic function following ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention. They found that patients with RD renal dysfunction (RD) had higher 6-year mortality and that renal dysfunction RD at admission was a strong independent predictor in patients with impaired left ventricular systolic function but not in those with preserved left ventricular systolic function (LVEF >50%).…”

“…Additionally, in the literature, most of the studies on this issue used LVEF only as a confounding factor to be corrected in the regression analysis. Savic et al ( 1 ), however, have classified patients into categories with respect to LVEF. Within each LVEF group, patients with RD had a worse outcome both in the short and long terms ( 1 ).…”

“…Savic et al ( 1 ), however, have classified patients into categories with respect to LVEF. Within each LVEF group, patients with RD had a worse outcome both in the short and long terms ( 1 ). In HORIZONS-AMI trial ( 3 ), LVEF <40% at admission was an independent predictor of 1-year mortality in patients with STEMI, whereas LVEF of 40%-50% was not related with negative outcomes.…”

Evaluation of renal dysfunction after STEMI

“…We have read with great interest the article entitled “Prognostic impact of renal dysfunction on long-term mortality in patients with preserved, moderately impaired, and severely impaired left ventricular systolic function following myocardial infarction” recently published in Anatol J Cardiol 2018; 20: 21-8 (1). In this study, the authors aimed to evaluate the prognostic impact of renal dysfunction (RD) on long-term overall mortality at admission to hospital in patients with STEMI.…”