Patients with STEMI and severe renal insufficiency were significantly less likely to receive optimal medical care and had higher 12-month MACE rates (37.4% vs 8.7%) compared to those with normal renal function.
Observational (n=7,679)
Open-label
Yes
Does renal insufficiency reduce the likelihood of receiving optimal medical care and worsen clinical outcomes in patients with STEMI?
Renal insufficiency in STEMI patients is associated with a lower likelihood of receiving guideline-directed medical therapy and timely reperfusion, contributing to significantly worse clinical outcomes.
Absolute Event Rate: 37.4% vs 8.7%
p-value: p=<0.001
BACKGROUND: The clinical outcomes of ST-segment elevation myocardial infarction (STEMI) are poor in patients with renal insufficiency. This study investigated changes in the likelihood that patients received optimal medical care throughout the entire process of myocardial infarction management, on the basis of their glomerular filtration rate (GFR). METHODS: This study analyzed 7,679 patients (age, 63 ± 13 years; men 73.6%) who had STEMI and were enrolled in the Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to August 2008. The study subjects were divided into 5 groups corresponding to strata used to define chronic kidney disease stages. RESULTS: Patients with lower GFR were less likely to present with typical chest pain. The average symptom-to-door time, door-to-balloon time, and symptom-to-balloon time were longer with lower GFR than higher GFR. Primary reperfusion therapy was performed less frequently and the results of reperfusion therapy were poorer in patients with renal insufficiency; these patients were less likely to receive adjunctive medical treatment, such as treatment with aspirin, clopidogrel, β-blocker, angiotensin-converting enzyme (ACE) inhibitor/angiotensin-receptor blocker (ARB), or statin, during hospitalization and at discharge. Patients who received less intense medical therapy had worse clinical outcomes than those who received more intense medical therapy. CONCLUSIONS: Patients with STEMI and renal insufficiency had less chance of receiving optimal medical care throughout the entire process of MI management, which may contribute to worse outcomes in these patients.
Choi et al. (Tue,) conducted a observational in ST-Elevation Myocardial Infarction (STEMI) and Renal Insufficiency (n=7,679). Severe renal insufficiency (GFR < 15 mL/min/1.73 m2) vs. Normal renal function (GFR ≥ 90 mL/min/1.73 m2) was evaluated on 12-month major adverse cardiovascular events (MACE) (p=<0.001). Patients with STEMI and severe renal insufficiency were significantly less likely to receive optimal medical care and had higher 12-month MACE rates (37.4% vs 8.7%) compared to those with normal renal function.