Key result
Improvement or stabilisation of renal function at one year in STEMI patients with kidney dysfunction was associated with a reduction in MACE (HR 0.51; 95% CI 0.35-0.75; p=0.001).
Why the study?
Renal dysfunction in STEMI patients undergoing pPCI indicates poor long-term prognosis, but the prognostic value of renal function improvement or stabilisation during follow-up had not been assessed.
Does improvement or stabilisation of renal function at one year improve long-term prognosis in STEMI patients with renal dysfunction undergoing primary PCI?
Cohort (n=2,170)
No
Does improvement or stabilisation of renal function at one year improve long-term prognosis in STEMI patients with renal dysfunction undergoing primary PCI?
Hazard Ratio: 0.51 (95% CI 0.35–0.75)
p-value: p=0.001
In STEMI patients with renal dysfunction at discharge, improvement or stabilization of renal function at one year is associated with significantly lower long-term MACE and all-cause mortality.
BACKGROUND: Renal dysfunction in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) indicates a poor long-term prognosis. However, the prognostic value of the improvement or stabilisation of renal function during follow-up has not yet been assessed. This study aimed to investigate the long-term predictive impact of the improvement or stabilisation of renal function after one year of follow-up in patients with STEMI undergoing pPCI with renal dysfunction at discharge. METHODS: This prospective, single-centre cohort study included 2170 consecutive patients with STEMI who underwent pPCI. The glomerular filtration rate (GFR) was determined at hospital discharge and one-year follow-up. The median clinical follow-up was 72 months. RESULTS: Among the 2004 patients, 393 (19.6%) had a GFR <60 ml/min, and 1611 (80.4%) had a GFR ≥ 60 ml/min at discharge. Among patients with GFR <60 ml/min, data at one-year follow-up were available for 342. Of these patients, 127 (32%) showed improvement in renal function (defined as improvement in the Kidney Disease Improving Global Outcomes (KDIGO) chronic kidney disease (CKD) classification), 47 (12%) showed worsening of renal function (defined as worsening of the KDIGO CKD classification), and 168 (43%) showed no category changes. Improvement or stabilisation of GFR at one year of follow-up was associated with a reduction of major adverse cardiovascular events (MACE) [HR 0.51, 95% CI: 0.35-0.75, p = 0.001] and all-cause mortality [HR 0.54, 95% CI: 0.34-0.84, p = 0.007] during follow-up. CONCLUSIONS: The improvement or stabilisation of renal function at one-year follow-up in patients with STEMI and renal dysfunction is associated with a better long-term prognosis.
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Rey et al. (2022) conducted a cohort in ST-elevation myocardial infarction (STEMI) with kidney dysfunction (n=2,170). Improvement or stabilisation of renal function vs. Worsening of renal function was evaluated on Major adverse cardiovascular events (MACE) (HR 0.51, 95% CI 0.35-0.75, p=0.001). Improvement or stabilisation of renal function at one year in STEMI patients with kidney dysfunction was associated with a reduction in MACE (HR 0.51; 95% CI 0.35-0.75; p=0.001).
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