Key result
Lower admission creatinine clearance linked to ~96% higher one-year mortality per tertile in STEMI cardiogenic shock.
Why the study?
Does admission creatinine clearance predict one-year mortality in STEMI patients with cardiogenic shock treated with PCI?
Cohort (n=193)
Does admission creatinine clearance predict one-year mortality in STEMI patients with cardiogenic shock treated with PCI?
Lower creatinine clearance on admission is strongly and independently associated with increased one-year mortality in STEMI patients presenting with cardiogenic shock and treated with primary PCI.
May refine prognostication in STEMI cardiogenic shock; hypothesis-generating and should not yet change practice.
BACKGROUND: Acute ST-segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock (CS) has still the highest in hospital mortality. Patients with STEMI and increasing creatinine levels within 24 h after admission have a poor prognosis. Data about STEMI complicated with CS and kidney function are sparse. We sought to assess the prognostic value of creatinine clearance on admission in patients with STEMI and CS treated with percutaneous coronary intervention (PCI). METHODS AND RESULTS: Between 1997 and 2005, a total of 3038 patients presented with STEMI and treated with PCI. On admission 292 patients presented with CS. Creatinine clearance (CrCl) could be calculated in 193 patients and classified in tertiles: group I > 96.8 ml/min; Group II between 67.5 and 96.8 ml/min; Group III < 67.5 ml/min. Overall one year mortality was 34%. In group I, II and III mortality was 24%, 30% and 45% respectively (P for trend 0.009). In multivariate logistic regression analysis, the odds for mortality increased with 96% for each tertile of admission CrCl (OR 1.961, 95%CI 1,135-3.385, P=0.016). CONCLUSION: Creatinine clearance on admission is strongly associated with one year mortality in STEMI patients with CS on admission and treated with PCI.
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Vis et al. (2009) conducted a cohort in STEMI complicated with cardiogenic shock (n=193). Lower creatinine clearance on admission vs. Higher creatinine clearance was evaluated on One year mortality (OR 1.961, 95% CI 1.135-3.385, p=0.016). Lower admission creatinine clearance was associated with increased one-year mortality in STEMI patients with cardiogenic shock undergoing PCI (OR 1.96 per tertile; 95% CI 1.135-3.385; P=0.016).
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